i ii iv - ormco · the lip bumper alternative dr. craig andreiko turbo wire in theory &...

Xlooking back ten years of clinical impressions

VOL 10 NO 2 2001

clinical impressionsI N N O VAT I V E S O L U T I O N S F O R O R T H O D O N T I C C A R E

ciDr. Moles on

TMJ Diagnosis

Drs. Bennett & Hilgers on

Maintaining the Gain

Dr. Starnes on Retention

Dr. Rubin on Patient

Communication

Dr. Moles

PUBLISHED BY ORMCO CORPORATION • VOL. 3, NO. 4, 1994

CLINICALImpressions®



Dr. Andreiko & Mr. Payneon Archwire Coordination

Dr. Sarver on RPE

Considerations

The Tx Coord. Study Club on

Their Raison d’ etre

Drs. Pollard, Sager & MolesShare Copper Ni-Ti Insights

Dr. Andreiko

®CLINICALImpressions

Dr. Takemotoon Lingual

Extraction Tx

Dr. Brady on Copper Ni-Ti

Applications

Dr. Mayeson RPE Efficiencies

Dr. Rosenbergon Breakage

Costs

Dr. Swartzon Successful

Bonding

Dr. Takemoto

Dr. Saldarriagaon ArchwireSelection

Dr. Warrenon Copper Ni-Ti

Dr. Redmondon IncreasingStarts

Dr. Davis Looksto the Future

Dr. Wick AlexanderOn Arch Form

Dr. Ronald M. RonconeOn Managementvs. Mechanics?

Dr. James J. HilgersOn First Impressions

Dr. Alexander

®




CLINICALImpressionsPUBLISHED BY ORMCO CORPORATION • VOL. 4, NO. 4, 1995

Dr. Sarver on Nondiagnostic

Video Technology

Dr. Smith on Efficiency and

Profitability

Dr. Mayes on SimplifiedTreatmentMechanics

Drs. Blechman and Alexander

on Distalizing Molars

Dr. Sarver

Dr. Smith onTreatment Efficiency

Dr. Mayes on STM, Part 2

Dr. Hilgers Takesa Step Backward

Dr. Scott onthe Lokar Appliance

Dr. Smith



Dr. Bennett on the Art of Orthodontics

Dr. White Interviews Prof. Melsen and Dr. Fiorelli

Dr. Borkowski on a Video

Brochure

Dr. Mayes on the

New CBJ

Dr. Bennett

Dr. White onQuality

Dr. Eckhart onThe Office Tour

Dr. Starnes on Early Treatment

Dr. Scott onFacemask

Implementation




Dr. Boyd onThriving vs. Surviving

Dr. Hilgers on Functional Finishing

Dr. Mayes onCBJ Adjunctive Tx

Dr. Clark on Practice Valuation

Dr. Sachdeva on Copper Ni-Ti

Dr. Markowitz onProfessionalRelationships

Dr. Hilgers on Scheduling

Dr. Boyd


CLINICALImpressionsDr. Roblee on IDT

Dr. Hilgers on Bios

Dr. White on Bond/Band Failure

Dr. Boyd on Missing Laterals

Dr. Eckhart on Patient Newsletters

Dr. Roblee


®

Dr. Clark on Marketing Plans

Dr. Chastant on SS Crowns

Dr. Haltom on PracticePromotion

Dr. Starnes on Bite Orthotics

Dr. Mayes on Bite Turbos

Dr. Hilgers on Retention

Dr. Clark on Marketing Plans

Dr. Chastant on SS Crowns

Dr. Haltom on PracticePromotion

Dr. Starnes on Bite Orthotics

Dr. Mayes on Bite Turbos

Dr. Hilgers on Retention



Dr. Black on the Patient-CenteredModel

Dr. Harfin on Implants for Missing Laterals

Dr. Bedette on the Net

Dr. Alexander on Retention

Dr. Black



Dr. Burk on Copper Ni-Ti Versatility

Drs. Epstein,Mantzikos and Shamuson Recontouring

Dr. Bagden on SpaceClosure

Dr. Mayes on theFrozat Dr. Weinberger

Dr. Weinberger 0nFirst Impressions



Dr. Drake on Budgeting

Dr. Burk on the Express-Nance

Dr. Mayes on the MMBJ Dr. Fillion

Dr. Fillion on the LingualOrthodonticResurgence

PUBLISHED BY ORMCO/ “A” COMPANY • VOL. 7, NO. 3, 1998


Dr. Eckhart on the MARA

Dr. Dischinger on Teamwork

Dr. Harfin on SpiritMB

Dr. Burk on RPEEnhancement

Dr. Epstein on Orthos Bi-Dimensional Tx Dr. Eckhart



Dr. Smith on Herbst Therapy

Dr. Odom on Indirect Bonding

Dr. Wildman

Dr. Wildman on the

TwinLock Appliance

PUBLISHED BY ORMCO • VOL. 9, NO. 2, 2000


Dr. Pitts on aNew Model ofEconomy

Dr. Mayes on Curing Lights

Drs. Hilgers & Tracey onBioprogressivePrinciples

CLINICALImpressions

DR. DIRK WIECHMANN

DR. WIECHMANN ON LINGUAL, PAGE 2 • DR. BOGDAN ON DAMON, PAGE 8 • DR. EVERSOLL ON ORTHO SOLO, PAGE 10 • DR. PAZ ON COMPACT RPE, PAGE 12 •

DR. ECKHART ON THE MARA, PAGE 16

®




Dr. Cordray on Precision Tx

Dr. McFarlane on Staff Motivation

Dr. Fillion onNew Lingual

Archwires

Dr. Smith on Herbst Tx Protocol

Dr. McClellan on Marketing via

Education

Dr. Cordray



Dr. Damon on The New Damon

Dr. Awbrey on The Bite Fixer

Dr. Scott on The Orthos Solution

…anda Message from Dr. Larry Andrews

Dr. Damon





Dr. Dischinger on Full-Face Orthopedics

Dr. Barnetton Revenue Management

Dr. Mayeson Bite Jumper Enhancements

Dr. Eversoll on Commitment

Dr. Bagden on Sliding Mechanics

Dr. Scott on MaxillaryProtractionTherapy

Dr. Eckhart onSnoring/SleepApnea

Dr. Miranda on ImprovedMouthguardProtection

Dr. Hilgers’Pendulum Update

Dr. Mario PazOn Lingual

Orthodontics

Dr. Jerry ClarkOn PracticeValuation

Dr. M.F.TalassOn Clean Wire

Mechanics

Dr. Michael SwartzOn Utility Arch

Efficiency

Dr. Dischinger



Dr. Grummons on Asymmetry

Dr. Scott on a Take-Home CD-ROM

Dr. Littlejohn on Vision

Drs. Epstein and Tran on Bite Opening

Dr. Swartz on Light Curing

Dr. Tracey on Aesthetics


CLINICALImpressions ®

Dr. Tracey on the Aesthetic-DrivenPractice

Dr. Bennett on Extending Treatment Intervals

Dr. Hutta on Herbst CrownRemoval

Dr. James Hilgers...Knowing When To Say When

Dr. Wick Alexander...The Lip Bumper

Alternative

Dr. Craig AndreikoTurbo Wire in

Theory & Practice

Dr. Hilgers

TM

PUBLISHED BY ORMCO CORPORATION VOL. 1, NO. 3, 1992

TM


TM


Dr. Eckhart onPractice Marketing

Dr. Bennett &Dr. Hilgers on The NoncomplianceAppliance

Dr. Baker onThe Eastman Program

Dr. Moles on The TMJ

Connection

Dr. Mayes on theCantilever Herbst

Dr. Hilgers on Scheduling - Part II

Dr. Spiegel onThe Focus Group

Dr. Mayes Dr. Baker


®


®


TM

Dr. Gorman Dr. White Dr. Sachdeva



®

®


CLINICALImpressions®CLINICALImpressions CLINICALImpressions CLINICALImpressions CLINICALImpressions CLINICALImpressions

®

XFrom Charles Lindbergh’s time until

now, orthodontic technology has changed almost as

dramatically as aviation technology, yet many of us

are resistant to capitalize on a key aspect of what

technology has to offer — extending treatment inter-

vals beyond the traditional monthly visit. While some

doctors with whom I have spoken have pushed treat-

ment intervals to 6 or 8 weeks, they are reluctant to

capitalize on the full capabilities of the new technolo-

gies. They purchase all the advanced products but

still use those products in the same old ways.

I am thoroughly

convinced that the most

successful practices in

the new millennium will

be, first and foremost,

obsessed with aesthetics.

The number one enemy to

efficient, biologically compat-

ible tooth movement in clinical

orthodontics is the way archwires are

tied. If we can decrease friction and

lower force levels, we can change the

dynamics of tooth movement.If you take only one idea

from this article, let it be this:

make bonding and precision place-

ment of brackets your number one

doctor-time priority.

Once we started using non-

compliance appliances in our

office, previously uncooperative patients developed

an entirely new attitude. Now the atmosphere in our office

is very positive....

Every contact is a

chance to meet an

expectation, exceed an

expectation or fail to meet an

expectation. Our lowest accept-

able standard is to meet a

patient’s expectation.

No longer will you be isolated in your practice; theWorld will be one giant group practice that willallow the exchange of ideas and treatment methods

on a daily basis.

I have come to believethat practice enhance-ment can be boiled down to oneword. Without this one wordworking in your practice, the oddsare against long-term prosperity.And that word is HONOR.

What separates the original patented ”A”

Company Straight-Wire Appliance system from all other

bracket systems is the ability to consistently deliver The

Look of Natural Beauty™, which is what patients want

and what orthodontists want to provide for their patients.

Treatment protocols

are the fundamental

building blocks for

effective staff and

patient education,

communication and

scheduling.

notableQUOTES

I II

III

IV

VIIIIX

X

VII

V

VI

Over the last ten years, doctors have shared their philosophies,

special techniques and private hopes for the orthodontic profes-

sion with both passion and intelligence in Clinical Impressions.

The following are notable quotes taken from back issues of CI.

The authors are identified at the bottom of the page.

I.Tom Pitts, Reno, NV / Vol. 9, No. 2, pg. 12. II.Keith Black, Asheville, NC / Vol. 6, No. 3, pg. 4. III.Dwight Damon, Spokane, WA / Vol. 8, No.2, pg. 6. IV.Stephen Tracy, Upland, CA / Vol. 8,No. 3, pg. 21. V.Tucker Haltom, Albuquerque, NM / Vol. 6, No. 1, pg. 12. VI.Bob Smith, Winter Springs, FL / Vol. 8, No. 1, Pg. 22.VII.Terry Dischinger, Lake Oswego, OR / Vol. 7, No. 4,pg. 4. VIII.Frank E. Cordray, Worthington, OH / Vol. 8, No. 1, pg. 3. IX.Randall K. Bennett, Salt Lake City, UT / Vol. 9, No. 1, pg. 8. X.Ray Bedette, Auburn, ME / Vol. 6, No. 3, pg. 12.

00

Taking the guesswork out of wire selection

ALAN BAGDEN, DMD

Crystal-clear sapphire brackets, the inspired

alternative to Invisalign

STEPHEN TRACEY, DDS, MS

Power whitening, the finishing touch to

beautiful, straight teeth

DEBRA F. COOK, DDS, MS

Putting your patients first – transforming

orthodontic visits into positive experiences

HAROLD ENOCH, DMD, MS

AOA/PRO CORNER

Choosing bands or crowns to anchor Herbst and MARA appliances

AAO FEATURE

Loose brackets – minor inconvenience

or profit vacuum?

RANDALL K. BENNETT, DDS, MS

Successful molar bonding with single

gingivally offset buccal tubes

MICHAEL L. SWARTZ, DDS

Tracking, analyzing and preventing emergencies

LORI GARLAND PARKER, MA, CLINICAL CONSULTANT

© 2001 Ormco Corporation 1717 W. Collins Ave., Orange, CA 92867

Printed in U.S.A.

2

8

11

14

16

18

22

30

32

contents

VOL 10 NO 2 2001

editor’sNOTEPAD

As the new editor of Clinical Impressions (CI), I found myself

with quite an issue to prepare. Yes, believe it or not, this is the

10th Anniversary Edition of Clinical Impressions (1992-2001).

As you can see from our front cover, quite a few faces in the

orthodontic profession have adorned our covers over the past

ten years. It is a tradition we plan to continue.

In celebration of this milestone, we hope you will enjoy the

new look of CI. From the masthead . . . to the colors . . . to the

typefaces . . . and design elements, we have taken a fresh

approach to our pages that we think will invite you to read CI

for many years to come.

Looking back, Floyd Pickrell, then President of Ormco, said,

“The primary focus of Clinical Impressions will be on articles

by leading practitioners that will enable you to incorporate

products or appliance systems into your practice more easily,

with superior results and broader application.” And indeed,

when Clinical Impressions was introduced in 1992 by Henry

Hulan, he used his clinical and professional understanding of

the specialty to institute what has become a highly regarded

publication in the field of orthodontics. Barbara Brunner,

Manager Corporate Communications, said of Henry upon his

retirement in 1999, “He has been its master, shaping its course,

yet ensuring that each doctor kept his own voice.”

CI has been built on a firm foundation of presenting articles

covering a variety of subjects pertinent to your practice from

clinical to practice management to aesthetics to new technolo-

gy and so on. We hope you not only enjoy this tenth anniver-

sary issue but also find it to be useful in your practice as we

continue the great Ormco tradition.

Jan DeCarlo, CI Editor

another birthday candleJIM HILGERS LOOKS BACK ON TEN YEARS OF CLINICAL IMPRESSIONS

Every once in a while I am lulled into believing that

orthodontics has finally reached its zenith. I get the

orthodontic blahs and a vague sense that there

aren’t changes on the horizon that can restore my

professional inertia. Then wham, out of the blue, a

new technology or system comes along that creates

new excitement and stokes the fires of my passion

for this specialty. It never ceases to amaze me how

inevitably these changes seem to occur. Like clock-

work, innovation becomes evolution.

Just think about the changes we’ve experienced

in the last decade. Ten years ago I was seeing

patients on four-week intervals and using fairly

complex mechanics. My days were hectic and

packed with patients (I saw anywhere from 85 to

105 patients a day), functional appliances were an

enigma, and I didn’t know how to turn on the office

computer. Now, noncompliance treatment mechan-

ics drive our practice, we see 50 to 55 patients a day

on six- to eight-week intervals and as far as I can

tell, I’m doing a better overall job as a wirebender

(or preformed wire package opener). I still don’t

know how to turn on the office computer.

The first question a prospective patient asks is

not “Can you straighten my teeth?” it’s “Do you

have colors?” Lingual orthodontics has been born

and reborn, self-ligating brackets have gone through

the Damon SL and Damon System 2 iterations,

clear brackets have been cool, then uncool, then

cool again. We not only wet-field bond with Ortho

Solo, idealize with Orthos, power whiten with

BriteFinish, and retain with Bond-A-Braid, we also

do our level best to give everybody the toothy

nonextraction smile of Farah Fawcett…or Cameron

Diaz, if you’re too young to remember the original

Charlie’s Angels.

Clinical Impressions has been chronicling these

changes for a full ten years now. It was born as the

brainchild of Ormco under the steady hand of one

of orthodontics’ publishing icons, Henry Hulan. It

was designed to be a voice for pragmatic orthodon-

tists. Not overly fussy or scientific, just the impres-

sions of astute clinicians fighting in the trenches.

Part of orthodontists’ genetic code, I suspect,

includes finding resources that make their complex

lives a little less so. Clinical Impressions fits that bill

perfectly. It is easy to read, easy on the eyes, and

easy to understand.

I remember the excitement of being asked to be

the poster child on the cover of the first issue. I was

especially honored because I knew the potential of

such a publication and its probable impact on the

profession. I, along with many of my esteemed col-

leagues, have been so honored in CI. See Mom, I

finally got my 15 minutes of fame! Some say the

golden age of orthodontics is just beginning. I say

that it’s always been there – just getting better.

Happy birthday, Clinical Impressions, on your

tenth anniversary. Many, many more to come.

2

Wire selection has become a significant challenge

for orthodontists who want to avail themselves of

the most efficient and comfortable technologies.

How often do you find yourself selecting a wire and

then second-guessing the choice? There are differ-

ent archwire options for leveling, space closing,

opening bites and closing bites. Some are made of

steel and some of titanium alloys. There are wires

in any number of ideal arch forms, depending on

the technique you follow. Some are braided, some

are straight and some wires are twisted. We even

have wires that act differently depending on the

temperature at which they become active.

With all of these choices, it’s no wonder ortho-

dontists wrestle with wire selection on a daily basis.

We’ve come a long way since our predecessors bat-

tled with their solid gold “E” arches, but that doesn’t

mean we have it all figured out.

Technological advances in wire development

allow us to treat patients with even greater ease and

comfort. We want to do what’s best but sometimes

the prospect of change is daunting. Have you ever

asked the question, “How do I transition to a new

family of wires?” Or maybe, “What’s the equivalent

in another alloy to the wire I’m using now?”

Unfortunately, there are no simple answers, but

there are certain generalities that can be suggested

for some typical situations. The metallurgical may-

hem caused by wire selection in the orthodontic

office requires organization.

I have created a table to help simplify the con-

fusion associated with wire selection. It tracks the

use of popular archwire sequences from the 1970s

to the present according to degree of crowding

and treatment phase. They represent the cutting

edge of wire progression for a typical .018 slot size

in each decade.

Sensible wire progres-

sion offers the greatest

efficiency. The intent of

today’s wire progression

philosophy is, in most

cases, to place increasingly

more rigid and larger

rectangular wires in the

bracket as the case pro-

gresses. The numbers in

parentheses after each

wire in the chart indicate

relative wire stiffness as

stated in the Ormco Wire

Stiffness Comparison

Guide1. To determine an

appropriate wire progres-

sion, the clinician should

evaluate not only the

TAKING THE GUESSWORK OUT OF

Alan Bagden, DMD

Springfield, Virginia

THIRTY YEARS OF WIRE PROGRESSION CHANGES

Degree of Crowding Initial Phase Intermediate Phase Finishing Phase

Severe .012 Steel (80) .016 x .016 Steel (425) .017 x .025 Steel* (1750)

.014 Steel (150)

.016 Steel (250)

Severe .014 Ni-Ti® (25) .017 x .025 Ni-Ti (225) .017 x .025 Steel* (1750)

.016 Ni-Ti (50)

.016 x .016 Ni-Ti (75)

.017 x .025 D-Rect (125)

Severe .016 Copper Ni-Ti 35º (25) .017 x .025 Ni-Ti (225) .017 x .025 Steel* (1750)

.016 x .022 Copper Ni-Ti 35º (100) .017 x .025 TMA* (725) .017 x .025 Steel* (1750)

Moderate .014 Steel (150) .016 x .016 Steel (425) .017 x .025 Steel* (1750)

.016 Steel (250)

Moderate .016 Ni-Ti (40) .017 x .025 TMA* (725) .017 x .025 Steel* (1750)

.016 Steel (250) .017 x .025 Ni-Ti (225)

Moderate .016 x .022 Copper Ni-Ti 35º (100) .017 x .025 TMA* (725) .017 x .025 Steel* (1750)

.017 x .025 Copper Ni-Ti 35º (150) .017 x .025 Ni-Ti (225)

Mild .014 Steel (150) .016 x .022 Steel (1100) .017 x .025 Steel* (1750)

Mild .016 x .022 Ni-Ti (150) .017 x .025 TMA* (725) .017 x .025 Steel* (1750)

Mild .017 x .025 Copper Ni-Ti 35º (150) .017 x .025 Steel* (1750)

1970s 1980s 2000 *Can add reverse curve

wire selection

cross section of the wire but also the rigidity of the

alloy relative to stainless steel. For example, it is

usually counterproductive to place an .016 x .016

Ni-Ti wire with a stiffness value of 75 after an .014

steel wire with a relative stiffness of less than 150.

It will often only reverse progress and prolong the

patient’s treatment.

In recent years, wire options have grown to

include the Copper Ni-Ti family of wires. They have

become extremely popular, particularly over the past

five years, because they deliver lighter, more consis-

tent forces and are active longer than any other wire.

Copper Ni-Ti offers advantages for both the patient

and your practice. These wires are designed to be in

the patient’s mouth for extended periods of time, so

you use fewer of them and change less frequently.

You can carry a less-detailed inventory of archwires

while reducing the number of appointments in the

patient’s treatment plan. As technology advances,

there will be more developments in the arsenal of

wires. I find that for comfort and overall efficiency,

the Copper Ni-Ti family of wires is the most appro-

priate choice available.

References:1. Ormco Orthodontic Product Catalog, Section 6, Page 2 or referto the Web site at www.ormco.com.2. Swartz, M.: “Titanium Arch Wires. Understanding andOptimizing Their Use – Part I.” Pg. 3–4.

Dr. M. Alan Bagden, currently practicing inSpringfield, Virginia, received his dental medicinedegree from the University of PennsylvaniaSchool of Dental Medicine and his orthodontictraining from the University of Maryland. A diplo-mate of the American Board of Orthodontics anda fellow of the American College of Dentists, Dr. Bagden is a past president of the NorthernVirginia Dental Society and is former president ofthe Virginia Association of Orthodontists. As anadvocate of economical and time-efficient ortho-dontic treatment, Dr. Bagden has a special inter-est in clinically evaluating new and progressiveorthodontic products.

EFFECT OF FORCE ON WIRES

Most physical wire properties can be measured with astress-strain plot (load to deflection). The ratio of stressto strain (or the slope of the curve up to the elasticlimit) defines the wire’s modulus of elasticity or stiff-ness. A steep slope describes a relatively stiff wire witha high modulus of elasticity or high load/deflection ratesuch as stainless steel. Conversely, a wire with a lowload/ deflection rate would have a shallow slope to thecurve, a lower modulus of elasticity and could bedeflected a greater distance with a lower force such asCopper Ni-Ti (top chart)2. The capibility of titanium wiresto recover from deformation (resiliency) makes themhighly efficient.

Compare the properties of stainless steel, TMA andCopper Ni-Ti (bottom chart). This information translatesinto practical orthodontics by understanding that it isthe low load/deflection rate of titanium alloy wires thatallows you to engage a larger dimension wire into thesystem at an earlier point in treatment. Their resiliencyand low load/deflection allows for more efficient move-ment with less patient discomfort. Stainless steel, witha steeper slope and stiffness, is less resilient andserves best as an ideal finishing wire. Its inherent prop-erties allow the bracket system to be ideally expressed.The properties of Copper Ni-Ti are best suited for initialwires and stainless steel for finishing wires.

STRESS

gm

STRESS

gm

STAINLESS STEEL

TMA

CU NI-TI

HIGH MODULUS

HIGH LOAD/DEFLECTION

LOWER MODULUS

LOWER LOAD/DEFLECTION

STRAIN/mm

WIRE STIFFNESS PROPERTIES

MODULUS OF ELASTICITY (STIFFNESS)

STRAIN/mm

4

CASE 2

CASE 1

The following cases are representative of the types of crowding typically treated with the initial wire progression shown in the table onpage 2. These cases will give you an idea of how different Copper Ni-Ti archwires can be used in the initial treatment phase. After the initial wire and correction, the balance of the wires placed will follow the table.

PRETREATMENT

15-year-old male, Class II, division 1, with severe

crowding. Nonextraction case.

PROGRESS

Initial wires were .016 35˚C Copper Ni-Ti in the

maxilla and mandible to initiate basic leveling and

aligning. Intermediate wires (shown in photos) are

.017 x .025 Ni-Ti. After 18 months of treatment,

patient is now ready to move to .017 x .025 stain-

less steel to finish.

PRETREATMENT

58-year-old female, Class II, division 1, with mod-

erate to severe crowding and severe skeletal

discrepancies. Initiated nonsurgical treatment and

evaluated at six months for extractions and

orthognathic surgery.

PROGRESS

Initial wires were .016 Ni-Ti in the maxilla and

mandible to initiate alignment and leveling

without extreme forces. Six months into treat-

ment, orthognathic surgery was decided upon to

correct malocclusion with mandibular advance-

ment. Lower incisor was also removed to maxi-

mize surgical advancement. Intermediate wires

(shown in photos) are .017 x .025 stainless steel

wire in the maxilla and .017 x .025 stainless steel

vertical loop space-closing wire in the mandible.

CASE PRESENTATIONS OF WIRE SELECTION FOR VARIOUS CASE TYPES

CASE 4

6

CASE 3

PRETREATMENT

15-year-old male, Class I with moderate crowding.

Nonextraction case.

PROGRESS

The same wire was used for the initial and inter-

mediate phases (shown in photos), .016 x .022

35˚C Copper Ni-Ti in the maxilla and mandible.

After 13 months of treatment, the upper arch com-

pletely leveled and aligned. The left central incisor

in the mandible needs to rotate (notice the single

tie to rotate). The midline will align ideally when

the final rotation is complete. The .016 x .022 35˚C

Copper Ni-Ti can be used to finish or if the rigidity

or torque of the stainless steel is indicated, the

case can be finished with .017 x .025 stainless

steel wire.

PRETREATMENT

35-year-old female, Class II, division 1, with

moderate crowding. Previous treatment included

extraction of maxillary bicuspids.

PROGRESS

Initial wires were .016 35˚C Copper Ni-Ti in the

maxilla and .016 x .022 35˚C Copper Ni-Ti in the

mandible due to different degrees of crowding.

After 18 months of treatment, patient exhibits

excellent alignment and bite opening.

Intermediate wires (shown in photos) are .017 x

.025 TMA® T-loop in the maxilla to close upper

spaces. The initial .016 x .022 35˚C Copper Ni-Ti

continues in the mandible. The case will be fin-

ished with .017 x .025 stainless steel wire.

00

COPPER NI-TI CONSISTENTLY PROVIDES OPTIMAL FORCESFOR COMFORTABLE TOOTH MOVEMENT

Copper Ni-Ti® archwire consists of nickel, titanium, copper,and chromium. The addition of copper to nickel-titanium is asophisticated process that enhances the thermal-reactiveproperties of the wire and allows a clinician to match specificforce levels to individual treatment requirements and goals.This archwire is more resistant to permanent deformationand exhibits a greater springback than traditional Ni-Ti wire. It also demonstrates a smaller loading force for the samedegree of deformation, when compared with Ni-Ti wire,which makes it possible to engage severely malposed teethwith less patient discomfort and less potential for rootresorption. As technology advances into the twenty-first cen-tury, so does the orthodontic profession and its ability totreat individual patients quickly and comfortably. Ormco pro-

vides the clinician with three Copper Ni-Ti wire choicesdepending on treatment needs: 27ºC, 35ºC, and 40ºC. Theyare also available in a wide variety of arch forms, includingOrthos™,* Tru-Arch® and Broad Arch.“New alloys, geared to generate biologically consistent forces,enable the clinician to provide controlled and predictable toothmovement. Copper Ni-Ti demonstrates precise transformationtemperature control, is more resistant to permanent deforma-tion and exhibits a smaller drop in unloading force than nickel-titanium alloys. By applying the principle of variable transfor-mation temperature orthodontics with Copper Ni-Ti, I am ableto control tooth movement more efficiently.”

– Rohit C. L. Sachdeva, BDS, M Dent Sc*Distributed in Europe as Ortho-CIS.

8

With a market capitalization of over $500 million,

and a masterfully orchestrated, multimillion-dollar,

direct-to-the-public marketing campaign,

Invisalign® is a force that is hard to ignore. Let’s face

it; whether you love them or hate them, you have to

agree that Invisalign’s marketing savvy is driving

patients to orthodontic

offices in droves –

patients who want

straight teeth, patients

who want beautiful

smiles, and patients

who want to look their

very best, not just after

treatment but during

treatment as well.

Bravo to Invisalign!

But what about those patients who just don’t fit

Invisalign’s treatment criteria? Do you turn them

away or offer them a convincing alternative – an

alternative that’s just as clear and infinitely more

effective? An alternative called inspire!™.

Just like many of you, we have embraced the

Invisalign system as an exciting new treatment

option for our aesthetic-driven practice. We also

realize that many of the patients who are drawn to

our office by the lure of “orthodontics unwired”

need much, much more than a simple collection

of aligners. They need braces and the undeniable

advantages they afford. Rather than throwing up

our hands and crying uncle, we enthusiastically

offer those patients a clear alternative – crystal-

clear inspire! sapphire brackets that offer the

mechanical advantage to adequately treat even

the most demanding cases, while meeting the ever-

escalating demands of our patients for aesthetic

orthodontic treatment.

So how do you sell aesthetic brackets to those

patients who initially desire Invisalign? You begin

the process during the very first call. Whoever takes

that first new patient phone call should be well

crystal-clearsapphire brackets

THE INSPIRED ALTERNATIVE TO INVISALIGN

Stephen Tracey, DDS, MS

Upland, California

Dr. Steve Tracey combines innovative yet prudent orthodontic mechanics with a belief inthe limitlessness of our potential to create suc-cess. He has a practice in Upland, California, andserves as assistant professor at Loma Linda,where he earned his D.D.S. and M.S. in ortho-dontics and was named instructor of the year in1995. He has published several articles and lec-tured in 13 countries – all while having competedin the Ironman Triathlon, climbing Mt. Rainier andtrekking in the Amazon.

Figure 1. From the

very first phone call

on, staff members

pre-frame prospective

patients to believe

that their aesthetic

needs can be met in

more than one way.

versed in the various treatment options

available to those patients who want

aesthetic treatment. After answering basic

questions about Invisalign, trained staff

members should prepare a prospective

patient for the idea that they may not be a

candidate for Invisalign treatment but that

alternatives exist that will allow orthodon-

tic treatment in the most aesthetic manner

possible.

An example of scripting might include,

“We’re really excited about the latest tech-

nologies that allow us to create beautiful

smiles invisibly. Dr. Tracey will decide if

Invisalign is right for you. If not, we have

other ways we can give you the smile you’ve

always dreamed of without using those old-

fashioned, clunky braces you may be thinking

of. Did you know we now have braces made

of crystal-clear sapphire – the same material

used for expensive watch faces?” It’s really important

that new patients are “pre-framed” to believe that

their aesthetic needs can be met in more than one

way (Figure 1). Ideally, send the patient both an

Invisalign brochure and an inspire! model card*

along with a welcome letter prior to their first

appointment (Figure 2).

As in any sales presentation, the first appoint-

ment is extremely important for both the Treatment

Coordinator and the doctor to ask pertinent ques-

tions and be good listeners. Ask the questions,

“Have you or any member of your family or friends

ever undergone orthodontic treatment? And when was

that?” Many prospective patients assume that braces

are big and unsightly based upon past

experiences many years ago. Ask the

patient, “In the event you don’t meet the

Invisalign selection criteria, would you be

willing to consider treatment with braces

that are every bit as clear, if not more so,

than Invisalign aligners?” Getting the

patient to make a commitment to con-

sider additional treatment options up

front is an extremely effective sales

technique. Once a person makes a pub-

lic commitment, it is very difficult for

them to renege on that commitment.

Of equal importance is that the

Treatment Coordinator and doctor

exude enthusiasm for the various aes-

thetic treatment options available to the patient,

focusing primarily on the desired results and how

they will impact the patient’s life. Don’t apologize if

the prospective patient isn’t a candidate for

Invisalign treatment. Rejoice with them that they

can have the smile they’ve always dreamed of using

state-of-the-art braces that are unbelievably clear.

Paint a picture in the patient’s mind about how

their life will be different with a beautiful new smile

and how great they would look in invisible braces

(Figure 3).

Get Up Close and Personal

One of the best ways to engage customers in the

9

Figure 2. Prior to their

first appointment,

prospective patients

who express an inter-

est in Invisalign treat-

ment are sent model

cards for both

Invisalign and inspire!

along with a wel-

come letter.

Figure 3. Both the

doctor and Treatment

Coordinator paint a

picture in the

prospective patient’s

mind about how their

life will be different

with a beautiful new

smile, and how great

they will look in invis-

ible braces.

*Ask your sales representativeabout inspire! support materials.

10

Figure 2. To debond

inspire!, register the

specially designed plastic

debonding instrument

squarely under the gingi-

val and occlusal/incisal

tie-wings of the bracket,

then…

Figure 4. Pivot the instru-

ment toward the

occlusal/incisal edge in a

steady, confident motion.

Note: The patient is biting

on a wax wafer to provide

a stabilizing effect, mini-

mizing discomfort during

the debonding procedure.

Figure 3. To get the appro-

priate grip on the bracket,

squeeze the handles of

the debonding instrument

until they firmly meet,

and…

Figure 1. Zirconium

spheres fused to the base

of the inspire! bracket

with a binder creates

fillets that expand contact

with the bracket, yet

leaves undercuts, allowing

adhesive to flow between

and into them.

finding the balanceBOND RELIABILITY WITH SAFE DEBONDING

Single crystal alumina oxide has challenged orthodontic manufac-turers for years in striking a balance between appropriate bondstrength and safe debonding. I’ve spent some time with Ormco’sengineers to get a better understanding of how they overcamethe challenges with inspire!™.

Previous iterations of sapphire brackets have relied on achemical bond that is highly unpredictable and, because it’s creat-ed at the atomic level, significantly more powerful than we needin orthodontics. Inspire’s bonding is based entirely on achieving astrong mechanical bond. A good mechanical bond relies onundercuts on the base of the bracket into which adhesive canreadily flow. The undercuts provide the interlock for the bondingadhesive. Inspire’s undercuts are created by fusing zirconiumballs to its base, establishing fillets that expand the contact of thespheres to the bracket, yet leaving undercuts that allow adhesiveto flow between and into them (Figure 1). By controlling the uniformity and even distribution of the zirconium balls as well as the volume of the fusing binder and the size of the fillets,inspire’s bonding mechanism means the brackets will stay putuntil the end of treatment.

Pivot Method for Debonding inspire!

Collapsing a ceramic bracket from its mesiodistal sides can splin-ter it. Debonding inspire! is safe and easy using the recommend-ed pivot method with the specially designed plastic debondinginstrument. The pliability of the instrument distributes thedebonding force load across the expanse of the bracket andallows you to get a firm grip without breaking the bracket. Todebond, register the debonding instrument squarely under thegingival and occlusal/incisal tie-wings. If you are using bracketswith hooks, squarely engage one set of tie-wings occlusally/gingivally while the pliers are flush against the hook. Squeeze thehandles together until they firmly meet, then pivot the instrumenttoward the occlusal/incisal edge in a steady, confident motion(Figures 2-4). The debonding pliers are designed to be used fordebonding one case, then discarded.

TOOTH

BRACKET

ADHESIVE FILLET

ZIRCONIUM SPHERES

sales process is to involve them by allowing them to experience

your product first-hand. Let the patient see and touch the

inspire! brackets. Have meticulously clean typodonts with

inspire! brackets available for the patient to see, touch and feel.

Show them photos of patients in clear braces, and if possible,

share with them testimonials from patients who have under-

gone orthodontic treatment with inspire! brackets.

When describing inspire! brackets, use emotionally charged

words such as cutting-edge, crystal-clear, exciting, fabulous,

tremendous, and outstanding. And always use positive body

language cues. Lean forward toward the patient. Always main-

tain eye contact. And last but not least, be warm, friendly and

show interest.

If you do all this and believe wholeheartedly in your abilities

to change people’s lives through the magic of orthodontics, you

are sure to convert even the most hesitant patient into a treat-

ment start, whether it be with Invisalign or crystal-clear inspire!

sapphire brackets.

Did you see the headline last year that asked the

American public, “Who wants to have white teeth

like Regis?” You can’t look anywhere on television,

in the movies or magazines without noticing how

perfectly white celebrities’ and

movie stars’ teeth are. Regis

Philbin is a TV celebrity who

popularized pearly whites that

penetrated the American con-

sciousness right along with the

question, “Who wants to be a

millionaire?”

The popular magazine O, The

Oprah Magazine asked its readers

recently to write an article in

response to the question, “What’s

made the biggest difference to

your sense of well-being?” The first article pub-

lished in response was entitled, “Tooth Whitening

Gave Me More Confidence.” The article stated that

whitening teeth is one of the simplest yet most

dramatic changes people can make to their

appearance. People feel better about themselves

with whiter and brighter teeth, and it’s commonly

known that people respond to a dazzling, healthy

smile in a more positive manner.1

So what does this American cultural phenome-

non have to do with

you, an orthodontist?

Society’s preference for

white teeth has made a

profound impact on

our patients. The

majority of them come

to the office concerned

about aesthetics and

want the best possible

smile. The best smile

doesn’t just include straight teeth and a good

occlusion, it includes the whole package. Patients

who are interested in straight teeth are interested

in straight, white teeth. They’re interested in

obtaining a brilliantly white smile that projects a

youthful appearance.

Orthodontist’s Role in Power Whitening

The orthodontist has numerous advantages over

the general dentist when it comes to an in-office

power whitening service. Patients connect improv-

ing their smile with their orthodontist, not neces-

sarily their dentist. During the course of treat-

ment, your patients’ comfort level increases

because of the frequency of their visits and the

treatment progress they see. It’s a natural progres-

sion from straightening teeth to whitening teeth.

The potential candidate is already your patient, so

you can offer power whitening as the finishing

touch, providing the whole package. Our ortho-

dontic practices are also well suited to offer this

service because we generally have a greater num-

ber of treatment chairs and staff to perform the

whitening procedure. In some states, regulators

have even approved orthodontic assistants to

perform the whitening procedure when in the

presence of an orthodontist.

power whiteningTHE FINISHING TOUCH TO BEAUTIFUL, STRAIGHT TEETH

Debra F. Cook, DDS, MS

Mission Viejo, California

THE BEST SMILE DOESN’T

JUST INCLUDE STRAIGHT

TEETH AND GOOD

OCCLUSION, IT INCLUDES

THE “WHOLE” PACKAGE.

Dr. Debra Cook received her D.D.S. and M.S. inorthodontics from Loma Linda University. She was arecipient of the California Dental Association Scholar-ship Award and selected to Omicron Kappa Upsilon(Phi Beta Kappa). She is a member of the Tri-CountyDental Society, California Dental Association,California Association of Orthodontists, Pacific Coast Society of Orthodontists and AmericanAssociation of Orthodontists. Dr. Cook has been inpractice for 2 1/2 years as an associate at the officesof Drs. Jim Hilgers in Mission Viejo, California, andSteve Tracey in Upland, California.

12

First Step: Survey Your Referring Dentists

When you consider offering whitening, an impor-

tant step is to survey your top referring general

dentists. Don’t underestimate the importance of

this step. Call your referring dentists out of cour-

tesy to tell them you’re considering adding this

service. Ask if he or she minds if you offer this

service to the patients they refer to your practice.

We called our top nine referring dentists. Seven felt

it wasn’t an issue. What’s more, after the initial

whitening, the patient will likely contact their

general dentist for any follow-up whitening. It can

also open the door for patients to consider other

cosmetic restorative dentistry from their dentist.

Power Whitening for Immediate Results

For years, dentists and orthodontists have been

using an at-home method of whitening using

custom-fitted trays and a diluted concentration of

a whitening gel, usually carbamide peroxide. Al-

though this method will work eventually, it’s very

time-consuming and takes a great deal of patience

and compliance. Technology has come to the rescue

with higher concentrations of whitening gels that

will, in the presence of a strong light source, make a

profound difference in discolored teeth in a matter

of minutes (Figure 1).

The exciting news in power-whitening products

is BriteFinish™. With this system, it now takes about

an hour of in-office time (Figure 2) to successfully

accomplish a dazzling white smile (Figure 3).

BriteFinish is a 35% hydrogen peroxide gel that is

activated using the Demetron Optilux 501 curing

light. Our patients use take-home custom bleaching

trays for about two hours several nights in a row to

achieve the final desired whitening. The patient kit

contains a 10% mint-flavored carbamide peroxide

gel. It is important to explain to your patient that

power whitening will last an average of about two

years with periodic at-home touchups. This esti-

mate will obviously vary depending on the patient’s

personal habits. Smoking as well as dark foods and

drink will diminish results more quickly.

How to Charge for Whitening

Advising your patients that you offer power whiten-

ing will open the door to numerous requests for the

procedure. The perfect time to introduce this serv-

ice is the initial visit. The orthodontist and

Treatment Coordinator should help the patient

visualize what they want their smile to look like,

emphasizing that straightened teeth look even bet-

ter if they’re whitened. You can use the BriteFinish

patient brochure to make this point with the

before and after photos.

The fee for whitening will vary by area of the

country and even office to office. Your fee schedule

my include a plan combining the full in-office and

take-home whitening procedure plus a fee for the

take-home procedure alone. You can also incorpo-

rate the power-whitening service into the overall

payment plan, allowing the patients to spread the

extra cost over their active treatment time. For

patients already in treatment, mention the power-

whitening process as they are nearing the end of

their orthodontic treatment. Patients will be much

Figure 1. We use a

shade guide to deter-

mine the shade of the

patient’s teeth prior

to whitening so we

can demonstrate the

immediate difference.

Figure 2. In addition to BriteFinish, a typical tray setup for

whitening includes goggles, NOLA cheek retractor, cotton rolls,

prophy angle, acid etch and vitamin E gel capsules to use in

case any bleaching material splashes on tissue.

13

happier with their overall experience. When we remove a

patient’s brackets, we offer a $50 gift certificate toward the

whitening process as an extra incentive for them to choose

smile brightening in our office.

With proper patient selection and effective marketing,

power whitening can be a wonderful adjunct for the practice

seeking to improve patient satisfaction and esteem.

Reference: 1. Kozolchyk, A.: “The Best Beauty Decision I Ever Made,” O, The Oprah Magazine, Vol. 2, No. 1, 2001, Pg. 76.

BRITEFINISH BASIC TECHNIQUES

Apply layer of Gingival Barrier 4-6 mm wide on gingiva. Sealinterproximal spaces. Overlap 0.5 mm onto dry enamel to seal.Extend resin one tooth beyondlast tooth bleached.

Remove gel with cotton roll orsuction, being careful not tosplatter material.

Visually check that all gingivaltissues at resin margin are coveredand seal is established. Light cureresin 20 seconds per light guidewidth.

Apply 1 mm layer of BriteFinishPower Gel (35% hydrogen perox-ide) on the labial surface of eachtooth.

Cured Gingival Barrier can beremoved easily. Remove any inter-proximal resin that remains.

Light cure for 10 seconds pertooth with Optilux 501 CuringLight (30 seconds with standardlights). Leave gel on teeth for 10-15 minutes.

Results after one appointment.When visible material is removed,rinse teeth and suction. Evaluateshade to determine if additionalwhitening is necessary.

Figure 3. BriteFinish patient displays final shade compared with

pretreatment shade.

the hollywood connection

Standards of what constitutes an attractive smile havechanged, and this change is influenced by cosmeticallyenhanced smiles flashed in movies and on television.Patients are now insisting on the whitest shades thatwere once considered fake looking. Dental manufactur-ers are also changing with the times. Lighter shadeproducts have been added to the bright end of thespectrum with names such as Bleach White andOpaque Snow.

The earliest records of bleaching vital teeth dateback to the early 1900’s and focused on the search foran effective bleaching agent to paint on discoloredteeth. Scientists discovered that the combination ofhydrogen peroxide and an accelerated reaction causedby devices delivering heat to teeth is a successful procedure for bleaching. Although it is not entirelyunderstood how bleaching removes discoloration, thebasic process almost certainly involves oxidation duringwhich the molecules causing the stains are released.The combination of heat and light appear to acceleratethe oxidation reaction. What was started in the early1900’s has become the basic foundation for the tech-nique used today in our power-whitening systems.

14

How is your practice run? We spend many years

learning how to be an excellent orthodontist. We

can move teeth and correct malocclusions, but

how we take care of our patients ultimately affects

the success of the practice.

My entire office staff and I

spend a great deal of time review-

ing patient care. Everyone has

heard that the first and most

important patient contact is the

initial phone call. That call is

absolutely the most important

first impression any office can

make. Every caller is greeted by a

polite, live voice – not a machine

directing the call. I believe that in

today’s electronic world, machines are taking over

too often as the link to a business’s communication

network. True, it may be more efficient but it also

makes the business experience very impersonal.

When patients enter our office they are greeted

with a warm smile from the receptionist (Figure 1).

There is always a fresh pot of coffee brewing, and

they are seen within five minutes of their scheduled

appointment. We try to be as respectful of their

time as possible.

A patient will spend not only a lot of money

but also a lot of time in

our office during their

course of treatment. I

feel it is very important

to explain the treatment

plan so that they under-

stand the value they are

receiving. We have

developed many mecha-

nisms to make sure we

communicate with our

patients. A separate

consultation is conducted to explain the proposed

treatment plan, financial requirements and insur-

ance coverage. This is an excellent opportunity for

questions and answers. Scheduling this meeting

before treatment builds the patient’s confidence in

our staff and helps to reduce questions during

treatment. At the conclusion of every appointment,

either the assistant who attended the patient or I

will walk the patient to the front desk. We explain

to the parent what was accomplished at the

appointment and what will take place during the

next visit.

Good follow-up is key in the communication

process. I find both verbal and written updates to

review patient progress are critical in good patient

cooperation. Every four to six months each patient

and their referring dentist receive a form reviewing

the progress of their treatment. Keeping the refer-

ring dentist in the loop shows the patient that you

are committed, while keeping your name in front

of the dentist.

There are two other aspects of good communi-

cation that go a long way in good patient care.

First, enable and trust your staff to make on-the-

spot decisions. Enabling your staff takes training

and education but will increase the positive way

your patients’ view your practice. Second, respond

Harold Enoch, DMD, MS

Marietta, Georgia

EVERYONE HAS HEARD

THAT THE FIRST AND

MOST IMPORTANT PATIENT

CONTACT IS THE INITIAL

PHONE CALL.

Dr. Harold Enoch graduated from the Universityof Florida Dental School in 1981 and WashingtonUniversity in 1983 with a certificate in orthodon-tics. Dr. Enoch has a private practice in Marietta,Georgia, where he has practiced for 17 years.He is a diplomate of the American Board ofOrthdontics and is a member of the AmericanAssociation of Orthodontists, SouthernAssociation of Orthodontists and AmericanDental Association. Dr. Enoch enjoys scuba div-ing, white water rafting, golfing and tennis. Heand his wife, Ina, have two sons.

putting your patients firstTRANSFORMING ORTHODONTIC VISITS INTO POSITIVE EXPERIENCES

15

to your patients’ concerns quickly, whether at the

office or with a follow-up phone call. They will

appreciate the attention and it will confirm that you

care about them as patients.

A few years ago I saw a niche that could be filled

in the area of patient care. Patients and parents do

not like to make the unplanned trip to the ortho-

dontist for minor repairs, missing work and school

for the unscheduled appointment. To help the

patient manage minor orthodontic repairs, I intro-

duced an emergency kit called Brace Solutions™ and

provide one to every new patient (Figure 2). It con-

tains a mouth mirror, push stick, orthodontic

emergency wire cutter, alcohol wipe, wax, instruction

booklet and place for the doctor’s business card

(Figure 3). This kit has been a major improvement

for both my patients and practice. Now the patient

can make a temporary repair like cutting a poking

archwire that is causing discomfort. It gives patients

and parents peace of mind when traveling or over a

long weekend. The emergency kit has increased our

efficiency and reduced emergency visits by 30%.

The combination of personal care, verbal and

written communications and on-time appointments

has helped transform our patients’ orthodontic visit

into a very positive experience and leads to new-

patient referrals. Every practice is different but with

practical principles like those I have outlined, you

can always improve patient care.

Figure 2. Kell Pallone explains how to use the emergency kit to a new patient and parent.

Figure 3. The orthodontic

emergency kit has reduced

the number of emergency

calls on evenings and

weekends. Visit

www.brace-solutions.com

for more information.

Figure 1. Receptionist Kelley Greyling always greets patients and their parents with a

warm smile knowing that they’ll be seen within five minutes of their scheduled appoint-

ment.

16

The Herbst and MARA appliances are currently the

most popular options for Class II correction ortho-

dontists use around the world. While designs vary,

the appliances have provided consistent, timely,

predictable and profitable results because they are

not dependent on patient compliance for success.

Stainless steel crowns were the first choice for

anchorage due to the superior strength of their

structure and shape. They have a large surface area

available to accommodate a variety of accessories

and devices with minimal breakage. Many ortho-

dontists who have advocated crowns as an anchor-

age system for the Herbst* or MARA appliances

sometimes use a combination of crowns and bands.

Others feel crowns are difficult to manage, so they

are more comfortable incorporating bands into

their appliance design. Most clinicians agree that the

primary advantage of banded Class II correctors is

ease of removal, which can be performed by trained

clinical staff in a short time.

Recently, modifications to the traditional ortho-

dontic molar band have increased its strength to

minimize potential breakage. Modifications include

thicker band material, .006 to .010 (Figure 1),

double bands laser-welded together (Figures 2a and

2b), a wire soldered to the occlusal surface of either

a traditional band or thicker .010 band (Figures 3a

and 3b) and solder-reinforced bands (Figures 4a and

4b). Reinforcement of these bands strengthens the

appliances and helps to minimize band tearing

under the forces they generate.

Due to the increased band rigidity, there are

several points to take into consideration.

1. While the laboratory indirectly fits both crowns

and bands on the work models, bands have limited

room for play in fitting on the tooth, especially

when reinforced. To ensure accuracy, it is recom-

mended to fit bands on the patient’s teeth.

2. Traditional bands may need to be sized a half

choosing bands or crownsTO ANCHOR HERBST AND MARA APPLIANCES

Figure 2a. A band

within a band (dou-

ble band).

Figure 2b. An example

of a double band

which Dr. Joe Mayes

uses.

MODIFICATIONS

TO INCREASE MOLAR

BAND STRENGTH

AND MINIMIZE

BREAKAGE.

Figure 1. Molar bands

measuring .006 to

.010 in thickness.

AOA Pro CORNER

17

size larger. This will help compensate for the loss of

stretch or reshaping properties of the band during

modification.

3. Take good alginate, or preferably polyvinyl silox-

ane, impressions to avoid distortions in the work

models used to fabricate the appliance. The bands

should be reset and secured in the impressions by a

pinning or gluing technique. Then pour using

orthodontic stone.

With advancements in today's technology, the

laboratory is able to accommodate most design

modifications requested. To minimize possible

exceptions and contraindications, the AOA/Pro

technical support team is always available to answer

questions regarding the design and performance of

the Herbst or MARA appliances to fit your patient's

unique treatment goal. Call Dave Nelson, Herbst

team leader, and Jerry Engelbart, MARA team leader,

at (800) 262-5221.

*Herbst is a registered trademark of Dentaurum.

Figure 3a. A wire

soldered to the

occlusal surface.

Figure 3b. Example

of a wire-reinforced

band which Dr.

Michael B. Rogers

advocates.

Figure 4a. A single

band encased with

solder.

Figure 4b. Example

of a solder-reinforced

band which Dr. Jim

Hilgers uses.

Dave Nelson joinedAOA/Pro over 13 yearsago and has been thesupervisor of the HerbstFabrication Departmentfor the past ten years.He oversees all aspectsof Herbst and metal pro-duction, including crownand band fit and seating,soldering, laser welding,cut and polishing andactivation. He communicates daily with doctors andstaff to fulfill their Herbst requirements and attendsHerbst appliance seminars and courses given by lead-ing clinicians.

Jerry Engelbart is thelead development tech-nician for the MARA atAOA/Pro. He began hiscareer in the dental laboratory field withProfessional Positionerswhere he worked for12 1/2 years. He movedto AOA six years ago.His experience includesfunctional and distaliz-ing appliances, adapters, acrylics, metals and specialtydesigns. Development of the MARA has been Jerry’sprimary focus for the past four years.

.

T I T A N I U M

A A O • T O R O N T O • M A Y 5 – 8 , 2 0 0 1 • O R M C O B O O T H 5 1 5 • N E

IT'S A MATERIAL WORLD…And the Material of Choice is Titanium

Introducing Titanium Orthos2™, combining two proven

performers – titanium, the 21st century alloy, and

Orthos, the only orthodontic appliance system whose

geometries and arch form are anatomically based.

For some of the same reasons that it has

improved golf swings and tennis lobs all

around the planet, titanium is going to have a

powerful influence on orthodontics. As

strong as stainless steel with equivalent

frictional properties, titanium has twice

its resiliency. Titanium Orthos2 acts as a

shock absorber, insulating the

adhesive bond from torque and

occlusal forces for greater bond

reliability and patient comfort.

Titanium is also highly corrosion

resistant and well documented in the

medical literature for its biocompatibility.

All this adds up to a bio-friendly, bio-durable bracket

in the proven Orthos prescription, now with new

anatomically designed pad configurations.

In the material world, the material that's setting new

standards is titanium. In the orthodontic world, that

standard is Titanium Orthos2.

W P R O D U C T S • B O O T H P R E S E N T A T I O N S • A A O • T O R O N T O •

19

INTRODUCING THE CARDOrmco's Ultimate Adhesive Dispensing SystemPrecise bracket placement is essential to an efficient, high-quali-ty result. The Card, Ormco's ultimate adhesive dispensing sys-tem, makes the bonding procedure itself more efficient.Under each protective foil bubble lies a tooth-specific doseof Enlight light-cure adhesive for an entire bonding (7-7). Using the sticky white circles for bracket set-up,peel back a single foil bubble, swipe the bracketthrough the adhesive, press and place, then light-cure with the Optilux 501 curing light. Quickand easy. The Card keeps flash clean-up to a mini-mum, stores easily and is date-stamped to ensurefreshness. And the best news…The Card is offeredcomplimentary with every 10 cases of Ormco bracketappliances purchased.

So now from Ormco you have The Card with Enlight light-cureadhesive…OptimeshXRT pad mesh with 35% improved bond reten-tion…and the Demetron Optilux 501 curing light for an efficient bondingsystem with proven bond reliability. Going to Toronto? Come into the Ormcobooth and swipe a few brackets. Get the feel of The Card.

Short Stick Power ”O”sNow in Vibrant ColorsYour patients want colors . . . lots of colors. You’re interested in features likesingle-patient use and convenience. Nowyou can have both with Short StickPower "O"s. The new configuration com-bines a tree of 10 power "O"s with a finger tab for easy handling. Designedfor single-patient use, it avoids crosscontamination while adding convenienceand decreasing waste.

Short Stick Power"O"s are available in24 vibrant colors andcoordinate withColored Power Chain.They are packed in1,000’s (100 trees/10each) and all are sized .120. Ask yoursales representativeto see the new ShortStick color choices.

Stimulating MandibularMovement with the SBJThe Standard Bite Jumper (SBJ) treatsClass II malocclusion quickly and econom-ically and your patients will appreciate itscomfortable design. The SBJ is anchoredusing stainless steel crowns at the upperfirst molars and lower first bicuspids.Enlarged pivot openings enhance lateralexcursions, increasing durability and side-to-side movement. The shape of the Hex-head screw is comfortable and offers bet-ter accessibility for adjustments. The SBJcan be fabricated in your office, so there’sno waiting or lab costs. For more informa-tion, contact your Ormco sales representa-tive or see it at the AAO.

Clinical Impressions live!Ormco Booth #515Ormco will feature in-booth presentationswith major clinicians from the orthodon-tic profession. These 30-minute presenta-tions will be lead by such doctors asTerry Dischinger, Steve Tracey, Mario Paz,Jim Eckhart and Rohit Sachdeva on avariety of topics relevant to your practice.

For the most up-to-date schedule, speak-er list and topics, visit the Ormco Website at www.ormco.com or visit theOrmco booth at the AAO to pick up aschedule.

M A Y 5 – 8 , 2 0 0 1 • O R M C O B O O T H 5 1 5 • N E W P R O D U C T S • B O O

MARAA simple, durable Class II corrector, theMARA has numerous benefits over otherfixed appliance techniques. Come see thenew ligation system and lower armdesign. Dr. James Eckhart and PaulaAllen-Noble will be presenting on theMARA at the AAO annual session.

Herbst AppliancesAs a popular noncompliance appliance,the Herbst®* provides predictable correc-tion of skeletal and dental Class II maloc-clusions. See all the options available toyou in Toronto and pick up a Herbst infor-mation book at our booth.

Distal JetThe Distal Jet distalizes maxillary firstand second molars and retains the resultwith one appliance. It produces unilateralor bilateral molar distalization and rota-tion corrections, typically in four to ninemonths, without patient compliance.

20

Optilux 501 Curing LightNamed Reality’s“Product of the Year”The Demetron Optilux 501 Curing Lighthas just been awarded “Product of theYear” for 2001 by Reality, publishers ofan information source book for aestheticdentistry. This prestigious honor followson the heels of “New Product of theYear” award for 2000.

Clearly the Superior Choicein Aesthetic Appliances –inspire!inspire!™ is the only crystal-clear sapphirebracket available in orthodontics. It’smade of pure, monocrystalline sapphirethat is chemically inert and will notabsorb, discolor or stain. Best of all it is aStraight-Wire® Appliance and you cancombine inspire! with any other Straight-Wire bracket within the arch without com-promising treatment. See the ultimate inaesthetic appliances in Toronto.

Interested in the latest advances in orthodontic laboratory appli-ances and services? Visit our lab pros at the AAO in Toronto. We'llbe conveniently located across from the Ormco booth. The AAO isan excellent opportunity for you to meet David Allesee, Max Hall,Paula Allen-Noble and other representatives and technicians on the

AOA/Pro team, and we look forward to assisting you. We're also fea-turing a number of speakers at Ormco's Clinical Impressions Live! ses-sions. Visit www.ormco.com to review the full schedule of speakersand times. Here are a few of the appliances you'll see on display inToronto. For additional information, call us at (800) 262-5221.

*Herbst is a registered trademark of Dentaurum.

AOA/PRO “ON DISPLAY” IN TORONTO • BOOTH 421

BriteFinish Teams Up withOptilux 501The Optilux 501 is the perfect companionfor the BriteFinish Power-WhiteningSystem. With BriteFinish and the 501, youcan provide one-visit, in-office powerwhitening that will give your patients abrighter and more perfect smile. AfterBriteFinish is applied, each tooth onlyneeds to be light cured for 10 secondswith the Optilux 501 special Bleach Modeas compared with 30 seconds per toothwith standard curing lights.

You can use the most powerful and ver-satile curing light available today – theDemetron Opitlux 501 Curing Light. It

greatly reduces the time required fordirect bonding procedures and will cureall light-cure adhesives. And now, the 501provides BriteFinish with an extra powerboost for a bright, beautiful smile and asatisfied patient.

21

O T H P R E S E N T A T I O N S • A A O • T O R O N T O • M A Y 5 – 8 , 2 0 0 1 •

Damon System 2It’s all about comfort . . . quality . . . andyour patients. The Damon techniqueemploys a specific combination of high-tech, low-force archwires in a coordinatedarch form to maximize the clinical poten-tial of the bracket design. This passiveself-ligating system facilitates toothmovement and controls torque and rota-tions quite differently from other bracketsystems. It is designed to stay within aforce level range throughout treatmentthat promotes patient comfort and bio-logically compatible tooth movement.See the Damon System 2 in Toronto orvisit http://damonsystem.com.

Pedo6 models in the primary dentition.

Gnathos9 models in the mixed and permanent dentitions.

Indirect Bonding ServicesIndirect bonding is becoming increasing-ly popular. AOA actively researches,evaluates and implements the latestinnovations in labial and lingual indirectbonding technology. We offer severalmethods and techniques. Our lingualservice also includes the CLASS, TARGand Fillion methods of bracket place-ment. Ask about our new Ortho Solo and Enlight LV bonding techniques.

Instrument Questions? See AEZ Founder, Al Ezcurra, in the Ormco BoothHere’s a rare opportunity to have your in-depth instrumentquestions answered when you meet Al Ezcurra, founder ofAEZ®, at the AAO. Visit the Instrument Station where Al willexplain features and benefits of the AEZ instruments plusgive you a hands-on demonstration of cutters, utility pliers,wire-forming pliers, debonding and adhesive-removing pli-ers, to name a few.

AEZ instruments, widely recognized for its pliers, are preci-sion fabricated from the highest grade of stainless steel barstock. All surfaces are polished and buffed until free ofimperfections and bacteria-collecting crevices. The resultis a smooth finish that will resist corrosion, peeling ordiscoloration from today’s rigorous sterilization proce-dures.

ETM® cutters are manufactured from surgical grade410 stainless steel, have diamond-honed tool steelinserts and are chrome plated. Noncutting instru-ments are made from technologically advancedXQ25 stainless steel forgings for unsurpassedcorrosion resistance, strength and durability.

Come see the entire line of high-quality AEZ andETM instruments at the Instrument Station in theOrmco booth at the AAO in Toronto.

Pro®-Pal ProductsOur complete line of consultation models, appliances and products offer your practice allthe tools necessary to enhance patient consultation and staff education. All Gnathos,Pedo and Master series feature descriptive imprinting, color-coded markings and coordi-nating upper/lower arches. Custom typodonts per your prescription are also available.

Randall K. Bennett, DDS, MS

Salt Lake City, Utah

The same scenario is played out in orthodontic

offices around the world. Everyday you end up in

the heat of battle. It’s three o’clock in the afternoon

and your waiting room is overflowing. All of your

two o’clock patients just arrived late because they

all waited for school to get out before coming to

the office. Your three o’clock patients are right on

time because they came directly from school and

your four o’clock patients are all early – they came

to the office when school got out rather than going

home first. It’s just another delightful afternoon of

schedule compression! The familiar refrain “wastin’

away in Margaritaville” sounds really tempting

right about now.

To add insult to injury, you quickly get behind

when one assistant discovers that Billy Brown has a

loose bracket. His mom insists that you rebond it

right now so she won’t have to make another

appointment for something you should have done

right in the first place. Instead of a scheduled 10-

minute appointment to simply check and retie the

archwires, you are stuck with 20 to 30 minutes of

chair time to rebond the bracket. Now the regularly

scheduled patients are going to have to wait even

longer. A few minutes later, Sally Smith admits to

her assistant that she has a loose bracket, too. All

this happens during the most hectic time of your

workday. Murphy’s law strikes again! It feels like it’s

time to order one of those portable blood pressure

monitors you saw in a catalog.

LOOSE BRACKETS = MULTIPLE PROBLEMS

One of the first steps in any 12-step program is to

admit you have a problem. Some orthodontists

realize that loose brackets are a problem in their

practices but many of us are in serious denial.

Repairing our work is wasteful of time and

resources and is stressful and inefficient. Loose

brackets lower morale, reduce profitability and

wreak havoc with scheduling. Nationally, it is

estimated that in the average office 25 to 30% of all

brackets placed will come loose sometime during

treatment. I have visited many practices where four

out of every five patients have one or more loose

brackets and the staff and doctor act as if this is

just a normal part of their day. It is amazing to me

that we would run our businesses this way. Many

orthodontic teams seem to have given up and feel

that it is less work to just live with the problem

than do the work necessary to solve it. I suppose

many of us feel that loose brackets are entirely the

patient’s fault and we are powerless to do much to

effect a dramatic change. The fact is that reducing

bond failure is within your control and there are

specific things you can do to reduce the problem.

DETERMINE SIZE OF PROBLEM

Zero percent bond failure is not a realistic goal, but

many practices have mastered the art and science of

reducing bond failure to acceptable minimums of

less than 5%. The average practice experiences sev-

eral loose brackets a day rather than a loose bracket

every several days. If you bond upper and lower

arches 5-5 (20 brackets per case) and start 20 cases

LOOSE BRACKETSMINOR INCONVENIENCE OR PROFIT VACUUM?

Dr. Randall Bennett received his M.S. in ortho-dontics from Loma Linda University and thenpracticed lingual orthodontics exclusively inBeverly Hills, California. During this time, he washeavily involved in lingual orthodontic research,writing and teaching. In 1989 Rand moved withhis wife and four children to Utah, renowned forits world-class family recreation. Currently Dr. Bennett practices in Salt Lake City and lectures nationally and internationally on practicemanagement, clinical efficiency and effectiveness.

22

per month, you will bond a total

of 400 brackets that month.

This does not include any of the

other individual bonds you

place. For example, Figure 1

shows that if you bonded 400

brackets per month, have an average bond failure rate (or BFR)

of 25% and work 4 days a week, you will experience 100 loose

brackets per month or 6 loose brackets per workday. If you

reduce your bond failure to 2%, you can see that you would

experience a loose bracket only every few days.

Based on Figure 1, make a guesstimate for your practice:

Total number of

- case starts per month _____

- brackets placed per month _____

- days worked per month _____

- loose brackets experienced per day _____

- bracket-failure rate _____

Would your staff agree with your guesstimate? In reality most

doctors and their staff underestimate the extent of their bond-

failure problems. To know for sure, you must carefully track the

number of new brackets placed and loose brackets experienced

to identify the size of the problem and determine the amount of

money you are losing each month. Knowing your exact bracket-

failure percentage can be a great motivator for lowering the

number, improving morale, increasing your profitability and

having a stress-free schedule.

It is key for you to believe that there are offices where a loose

bracket is an uncommon occurrence – not a daily event. The

quick and easy method of determining whether or not you have

a problem is: if you experience more than one loose bracket in your

practice every few days, you have a problem.

REALITY IN THE BUSINESS WORLD

Most businesses do not tolerate more than one in a million

defects and yet many orthodontists live with defect rates (loose

brackets) of one in four on a daily basis. An orthodontic office is

a business, and basic business training (had we received it

in school) would have taught us not to tolerate defects if we want

to run it effectively.

We make a huge mistake when we assume that a loose brack-

et costs only about the same amount as a replacement bracket. In

reality, there are a host of other costs that directly reduce the

profit piece of the practice pie. Each and every loose bond that

your practice suffers reduces your net income. The increased

costs to the practice are both tangible and intangible and none

of them should be overlooked.

PUBLIC RELATIONS COSTS

Mothers do not appreciate taking their children out of school to

fix problems that are your fault. Patients feel that loose brackets

are rarely their fault and are often reluctant to assume responsi-

bility for the problem. Someone is at fault, so it must be you or

your team. Patients expect flawless treatment and when a bracket

comes loose, expectations are not met, creating frustration.

Unhappy patients tell dozens of others about their negative

experiences but satisfied patients tell few.

PERSONNEL COSTS

Few things burn out staff quicker than dealing with irate moth-

ers. Stress begins with the discovery of a loose bracket at the

chair or a phone call to the office. Nobody is happy when a

bracket comes loose – not the parent, patient, staff member or

orthodontist. Every loose bracket produces frustration and stress

that take their toll on your team members.

SCHEDULING COSTS

The schedule always suffers when brackets come loose. You and

your staff members spend time repeating work previously com-

23

CALCULATING BRACKET FAILURE RATEB A S E D O N 4 0 0 B R A C K E T S B O N D E D P E R M O N T H

12 Workday 16 Workday Total Loose BracketMonth Month Brackets Failure Rate

Per Month1 every 3 days 1 every 4 days

1 every 2 days 1 every 2 days

1 per day Less than 1 per day

1.5 per day 1 per day

3 per day 2 per day

5 per day 3 per day

7 per day 5 per day

8 per day 6 per day

10 per day 8 per day

FIGURE 1

4

8

12

20

40

60

80

100

120

1%

2%

2%

5%

10%

15%

20%

25%

30%

24

pleted, and the parent and patient spend extra time

and mileage. Everyone involved would prefer to be

doing something else. No matter how fast and easy

it becomes to replace a loose bracket, you are still

repeating previously performed work. Labor is not

free and it always hurts your profitability.

CLINICAL SUPPLY COSTS

Many of the same supplies are needed whether

bonding 20 brackets for the first time or rebonding

one bracket for the second or third time. Patient

napkins, cotton rolls and other disposable items all

cost money. There is also a cost associated with

preparing the chair and cleaning up after the

appointment, as well as sterilizing all non-dispos-

able instruments. A new bracket is often used to

avoid another debond, but even if the bracket is

microetched and reused, there is still a waste of not

only time but also money. Often, a new wire needs

to be placed because the current wire has either

been clipped or will not fit into the newly rebonded

bracket. Bottom line: a loose bracket really is a

profit vacuum!

EXACT COST OF A LOOSE BRACKET

I’m not certain of the exact tangible cost of a loose

bracket, and orthodontists seem to vary in their

estimates from $25 to $150. In our office the true

cost is close to $100 per loose bracket. I have a hard

time imagining that in most offices the cost is less

than $75 per incident. And most offices charge

nothing for the extra work. Some attempt to charge

the patient but it often does more damage to their

public relations than it is worth. Does charging $25

for a loose bracket even come close to covering the

costs? I doubt it. By the time the doctor washes,

gloves up, sits down, talks with the patient, posi-

tions the bond, says goodbye, removes the gloves

and washes hands again, several minutes have

elapsed. Considerable staff time is spent to prepare

the chair, talk with the patient, untie or remove the

wire, prepare the tooth, position the bracket with

the doctor, replace the wire, clean up the chair for

the next patient, reschedule the patient, dismiss the

patient and sterilize the instruments. Consider all

the tangible supply and instrument costs,

disposable items, preparing trays, cleaning the

nondisposable instruments, sterilization, etc. Add

to those costs all of the intangible costs to the

practice. You end up with a problem that simply

should not be ignored.

Fill in the blanks of the cost of rebonding in

Figure 2, being realistic with your numbers.

Using Figure 3, you can see how an estimated

repair cost and annual number of case starts trans-

lates to dollars lost based on a percentage of bond

failures. If your bond failure rate is 25% and you

start 200 new cases per year, your bond failure rate

could cost you anywhere from $25,000 to $100,000

per year. Lowering your bond failure rate from 25%

to a barely acceptable 5% would cost you $5,000 to

$20,000 and save you $20,000 to $80,000 per year –

year after year! Is it worth the effort to calculate and

then reduce your bond failure rate to 5% or less?

HOW WE REDUCED BOND FAILURE

IN OUR PRACTICE

Ten years ago we finally admitted that we had a

problem that was costing a significant amount of

money each month. We knew the first step in

reducing the damage to the practice was to deter-

mine our exact bond failure rate, so we started

carefully counting brackets. This was easier to do

than I ever would have guessed. We created a Loose

Bond Card and filled one out for every loose brack-

et. In addition, we counted every new bracket.

(Refer to Lori Garland Parker’s article in this issue

CALCULATING THE COSTOF REBONDINGB A S E D O N O N E C L I E N T V I S I T W I T H A L O O S E B R A C K E T

COSTS EXPENSE

Patient Napkin

Cotton Rolls

Bonding Materials

New Bracket

New Archwire

Sterilization

Receptionist Time (10 min.)

Assistant Time (20 min.)

Doctor Time (10 min.)

Other Costs

Overhead Factor

Total

FIGURE 2

entitled “Tracking, Analyzing and Preventing

Emergencies.” She has developed a similar card,

which is shown.) Each assistant handed in the

numbers at the end of the day to a designated

tracking assistant (someone who liked keeping

track of numbers and was passionate and motivat-

ed to help minimize the problem).

After tracking the numbers for several months,

we discovered that we had a 22% bond failure rate!

If we had not carefully counted and calculated a true

percentage, I would have guessed we had much less

of a problem. Actually, I guessed that our bond fail-

ure percentage was probably about 10% and my staff

guessed that it was about 15%. Obviously, both

guesses were lower than reality. This is typical and

unless you count, you will guess you have less of a

problem than you actually have. As we have already

seen, the difference between a 25% and a 5% bond

failure rate can mean thousands of dollars that could

go straight to your bottom line – take-home profit.

25

FIGURE 3

$25/REPAIR 2% 5% 10% 15% 20% 25%

CASE STARTS

100 $1,000 $2,500 $5,000 $7,500 $10,000 $12,500

150 1,500 3,750 7,500 11,250 15,000 18,750

200 2,000 5,000 10,000 15,000 20,000 25,000

250 2,500 6,250 12,500 18,750 25,000 31,250

300 3,000 7,500 15,000 22,500 30,000 37,500

350 3,500 8,750 17,500 26,250 35,000 43,750

400 4,000 10,000 20,000 30,000 40,000 50,000

$75/REPAIR

100 $3,000 $7,500 $15,000 $22,500 $30,000 $37,500

150 4,500 11,250 22,500 33,750 45,000 56,250

200 6,000 15,000 30,000 45,000 60,000 75,000

250 7,500 18,750 37,500 56,250 75,000 93,750

300 9,000 22,500 45,000 67,500 90,000 112,500

350 10,500 26,250 52,500 78,750 105,000 131,250

400 12,000 30,000 60,000 90,000 120,000 150,000

$100/REPAIR

100 $4,000 $10,000 $20,000 $30,000 $40,000 $50,000

150 6,000 15,000 30,000 45,000 60,000 75,000

200 8,000 20,000 40,000 60,000 80,000 100,000

250 10,000 25,000 50,000 75,000 100,000 125,000

300 12,000 30,000 60,000 90,000 120,000 150,000

350 14,000 35,000 70,000 105,000 140,000 175,000

400 16,000 40,000 80,000 120,000 160,000 200,000

DOLLARS LOST FROM REPAIR COSTS B A S E D O N P E R C E N T A G E O F B O N D F A I L U R E S

Average number of new case starts per year as indicated in the 1999 JCO Orthodontic Practice Study.

Once we knew our bond failure rate, we insti-

tuted steps and set a goal of achieving a rate of less

than 5%. During the evaluation process, I discov-

ered that each assistant was using her own special

isolation technique, etching times, adhesive, etc. So

I went back to basic science and evaluated how we

prepared the teeth, isolated, etched, rinsed, dried,

sealed, etc., to make certain

that our technique was as

perfect as possible. A critical

article to review is “Achieving

a 95% Bonding Success Rate”

by Dr. Michael Swartz,

Clinical Impressions, Vol. 4,

No. 3, Page 14.

STEPS WE HAVE TAKEN

TO ENSURE SUCCESS

1. Thoroughly pumice

before bonding just to be

sure that all plaque is removed.

2. Isolate the teeth using a NOLA retractor and

Dri-Angles®, allowing complete control.

3. Thoroughly dry the teeth with air spray.

4. Etch with a dark gel etch. It stays in place and is

easy for the assistant to see.

5. Etch for the manufacturers prescribed 30 sec-

onds per tooth.

6. Thoroughly rinse each tooth for 3 to 5 seconds

with air/water spray, not just a light water rinse.

7. Thoroughly dry each tooth with air spray and

then use a NOLA air dryer to desiccate the enamel.

Key: Immediately apply activator (System 1+™) to

the etched enamel or a sealant like Ortho Solo™.

8. Place the bracket quickly and position it accu-

rately. Then leave it alone. Continued movement of

the bracket after the initial set will result in lower

bond strength. Be aware that an initial set will start

to occur with light-cured adhesives in ambient light

soon after placement. Even with light-cured adhe-

sives, wet-field adhesives and precoated brackets, I

still experienced much higher bond failure rates

than I do now with System 1+ adhesive.

9. Use lower force systems of wires to reduce the

pressure on the adhesive bond. We routinely use

Copper Ni-Ti® and TMA® wires in an .018 slot

Orthos™ bracket with Optimesh® XRT and gingi-

vally offset bicuspid pads. We rarely use stainless

steel wires anymore.

10. Buy expensive brackets because they stay on the

teeth. I would rather pay full price for the most

expensive bracket made and only encounter a

loose bracket every few days in a busy practice

than buy the cheapest bracket and have loose

brackets every day. Think about it... at a cost of

$75 per loose bracket, it only takes a couple of

loose brackets per case to cost you more than all

your brackets and wires combined to treat the

case. Cheap products are really extremely expen-

sive. You get what you pay for.

REEDUCATE YOUR TEAM

The next step of the process was to reeducate the

staff and help them understand why each step of

the bonding procedure is crucial to the overall

process and why shortcuts can result in a weaker

bond strength. Constant retraining and follow-up

is critical to the training process. Otherwise

entropy sets in and each staff member eventually

evolves their own special way of doing it (after

only a few short weeks), skipping steps and taking

shortcuts, which ultimately result in an increase in

bond failure.

TRACK LOOSE BRACKETS EVERY DAY

As we tracked the numbers day in and day out,

month after month, we watched our bond failure

rate steadily go down until we finally achieved a 2%

bond failure rate. It remained there for a number of

years and then we got complacent and lazy. We quit

focusing and counting for awhile before we all

sensed that we were encountering more loose

brackets. We started counting in earnest again and,

sure enough, our bond failure rate had risen.

Interestingly, we had hired some new clinical per-

sonnel and everyone had evolved their own bond-

ing system again – entropy had set in. So we

retrained again and slowly lowered the number. We

currently maintain a bond failure rate of 2 to 3%

and we are committed to never quit focusing on it.

The costs are just too high.

TRACKING BOND FAILURES

Assistants Role

• Count the number of new initially bonded brack-

ets each day (both new-start brackets as well as

individual bonds on cases in progress).

• Count the number of loose brackets rebonded

each day and fill out a Loose Bond Card. If you find

26

ORTHODONTICS IS A GREAT

PROFESSION. ORTHODONTICS

CAN ALSO BE A REWARDING

BUSINESS IF WE PAY

ATTENTION TO THE DETAILS.

a loose bond but choose not to rebond it, do not

count it as loose until it is rebonded. If you never

rebond it, then count it as a loose bracket on the

day that treatment is finished and all other brackets

are removed.

Statistical Assistants Role

• Tally the number of new initially bonded brackets

placed by all assistants each day.

• Tally the number of loose brackets rebonded (or

count at the debond finish appointments) by all

assistants each day.

At the end of the month, total the daily tallies

and calculate the bond failure rate. For example, if

you started 20 cases and bonded upper and lower

5-5, you would have placed 400 brackets on new

starts. Include any other new bonds placed on limit-

ed cases, or newly erupted teeth, and add another 50

brackets for a total of 450 new brackets. At the end

of the month you have rebonded a total of 50 loose

brackets and counted another 5 other loose brackets

at the debond appointments (which you did not

rebond) for a grand total of 55 loose brackets. Your

bond failure rate for that month would be 55 loose ÷

450 new = 12% bond failure.

It is important to note that you must track bond

failure long term to have an accurate number. If you

have an unusually large number of starts one month

compared to adjustment appointments, you will

have a larger-than-normal number of new brackets

that month, which will make your bond failure rate

that month seem much lower than it really is. If you

start using one particular bracket or new adhesive, it

will take many months before you gain an accurate

idea of what the relative bond failure rate is for that

particular type of bracket or adhesive.

Incidentally, in my practice we now bond upper

and lower 7-7 routinely. I was very reluctant to try

bonding molars because I assumed that molar

bonds would just fall off the teeth. A friend suggest-

ed that I try bonding molars because he found it to

be very successful. I overcame my fear of the

unknown, tried it and haven’t routinely banded

molars since. We now have less loose molar bonds

than with our previous method.

There are two other pieces of valuable informa-

tion to record and track that you will find helpful.

The assistant should record which tooth the bracket

was located on so possible patterns can be detected.

At one time, we found that lower left second bicus-

pids were coming off at an increased frequency

when compared with other teeth. After discussing

the issue, we found that some assistants found it

difficult to gain access to the lower left posterior

quadrant. The teeth were not being adequately

etched and then rinsed. So we trained and were able

to lower the incidence of those bond failures.

The assistant should also record where the fail-

ure occurred. Is there adhesive still on the tooth? If

so, the failure occurred between the bracket base

and the adhesive, indicating a bracket/adhesive

problem. Or, is the tooth surface free of adhesive?

If so, the problem is probably technique related,

indicating a problem with the tooth preparation,

etching, rinsing, drying, sealing and so on.

The ultimate step is to track each assistant’s

bonding stats so that each knows their percentage

of loose bonds and whether their bond failure rate

is going up or down. Loose bonds really do have a

lot more to do with us and our techniques than our

patients.

CELEBRATE YOUR SUCCESS

Success involves every member of the practice. As a

team, set a goal for how much you are going to

reduce the bond failure rate and celebrate when you

reach it. Reward yourself and your staff for reduc-

ing bond failure and eliminating the damage that it

does to your business. A bonus or incentive for

your staff is an excellent method to gain support

and create enthusiasm for the

project. The success you

achieve will increase your

profitability.

I should also mention

some clinical observations I

have made about other fac-

tors that have helped reduce

our bond failure rate. Using

low-force archwires such as

Copper Ni-Ti and TMA has

helped reduce the amount of

loose bonds. I found stainless steel wires seemed to

be related to a higher incidence of brackets popping

off the teeth. I also noticed that when we switched

from .022 to .018 slot that our loose bracket per-

centage went down. I have wondered if the fact that

we couldn’t place larger wires (i.e.; .019 round, .021

round, .019 x .019, .019 x .025, .021 x .025, etc.)

helped reduce strain on the adhesive bond, result-

27

ALBERT EINSTEIN SAID, “NOT

EVERYTHING THAT COUNTS

CAN BE COUNTED, AND NOT

EVERYTHING THAT CAN BE

COUNTED COUNTS.”

ing in fewer loose bonds. We currently see the

majority of our fully bonded cases every 10 to 14

weeks, unless they are noncompliant or specifically

need to be seen more often for a particular reason.

If our bond failure rate were still high, we would

definitely not be able to see patients at extended

intervals. Seeing a patient every month is necessary

if that patient has a lot of loose brackets and you

need to check regularly to rebond all the loose

brackets just to keep treatment on track. Reducing

bond failure allows you to take advantage of today’s

bracket and wire technology and extends treatment

intervals, letting the systems do their job for suc-

cessful treatment.

Orthodontics is a great profession. Orthodontics

can also be a rewarding business if we pay attention

to the details. Reducing bond failure is an easily

achievable goal and doing so can directly increase

profitability in your practice. Don’t be complacent

and just put up with loose brackets in your practice.

Albert Einstein said, “Not everything that

counts can be counted, and not everything that can

be counted counts.” Loose brackets are a phenome-

non that definitely can be counted, and bond fail-

ure definitely counts as something that can make a

huge difference in the quality of life for you, your

team, your business and, most importantly, your

patients.

28

IT’S STRICTLY A SOLOPERFORMANCEWITH ORTHO SOLOOrtho Solo is all you need – a universal adhesion-boosting primer and sealant all in one bottle. Itrequires only one application to the tooth structurewith no light-cure or air-dry step in the procedure,saving valuable chair time. Ortho Solo is much lesstechnique-sensitive and time-consuming than otherproducts, saving you steps in the bonding procedureand reducing your inventory.

Ortho Solo boosts bond strength and reduces costly bond failures

through a unique chemistry. . .

• Specific monomers act as adhesion boosters to enhance the

chemical and mechanical bonds.

• Its ethanol solvent displaces moisture, offering excellent

performance even when a dry field is compromised.

• Its glass filler, not found in most other sealants, acts like a shock

absorber for added strength.

Ortho Solo also works universally with light-cured, dual-cured

and no-mix adhesive systems. Now that’s convenient. Its one-step

performance helps reduce bond failures, lowers costs and saves

time. Talk to your sales representative today about the ONE and

only Ortho Solo.

0000

THE DAMON SYSTEM 2 – JUNE 29, 2001

videoconference

clinical procedures bracket placement consultations live question & answer

First-time users, long-time users,

doctors and staff...Join Dr. Dwight

Damon for this exciting simultaneous

nationwide videoconference where

he will share important techniques

for harnessing the full potential of

modern high-tech, low-force wires

through his passive self-ligating

system. Learn bracket placement

protocol and dozens of clinical

pearls for translating low-friction

mechanics into comfortable, efficient

tooth movement and high-quality

results. See Dr. Damon conduct

actual patient consultations and

learn firsthand why these patients

are driving up case starts. You can

even participate in a real-time

question and answer session. Fees for

this half-day event are $100 for doc-

tors and $25 for staff members (4 CE

units). Space is limited. Register early.

Contact Pat Contreras at 800-854-

1741, Ext. 7598 for the hotel location

in the city nearest you.

DamonSystem.com

ANAHEIM

ATLANTA

BOSTON

CHICAGO

CINCINNATI

DALLAS

DENVER

DETROIT

MIAMI

MINNEAPOLIS

NEW ORLEANS

NEW YORK

PHILADELPHIA

PHOENIX

ST. LOUIS

SALT LAKE CITY

SAN FRANCISCO

VANCOUVER

The routine bonding of first and second molars

has been problematic for many orthodontists.

Difficult access, requirements for auxiliaries and

additional buccal tube attachments and posterior

occlusion can all contribute to molar bond failures.

Currently, most orthodontists band molars but

would prefer to bond if failure rates could be

reduced to an acceptable level.

It would be reasonable to assume that to

improve molar bond retention, we should consider

all the possible contributing factors such as access

and visibility, buccal tubes, occlusion, and perhaps

the bonding area. A similar problem was encoun-

tered with bicuspid bonding. The successful bond-

ing of bicuspids seems to have been resolved with

the use of a gingivally offset bracket on a bonding

base that extended more occlusally1 (Figure 1).

The concept behind the bracket/base combina-

tion was to shift the bonding area more occlusally

to the less problematic middle and occlusal enamel

and not to simply increase the bonding area. A simi-

lar approach has been taken with the molar buccal

tube and bonding base design. I have been bonding

molars with this bondable molar buccal tube for the

past six years, achieving a failure rate of under 10%

on first and second molars (Figures 2 and 3).

In designing bondable molar tubes, limitations

were set on the placement and use. First, their use

was restricted to cases requiring only a single buc-

cal tubes with no auxiliary slots, headgear or lin-

gual attachments. Second, the size of the molar

bonding base was increased and the buccal tube

was welded at the most gingival edge (Figure 4).

Again, the intended purpose was to increase the

amount of the problematic occlusal third of the

enamel being bonded and decrease the amount of

more problematic gingival third enamel. And third,

additional care would need to be taken to gain bet-

ter access, visibility and saliva control for bonding

molars. For patients with limited access, a Dri-

Angle® (Figure 5) can be placed in both the buccal

and lingual vestibules. With the patient’s head tilt-

ed, a saliva ejector is positioned on the opposite

side of the molar being bonded. Using a finger or

mouth mirror, the buccal Dri-Angle and cheek is

retracted to expose the molars. This will often allow

almost direct access to the first and second molars.

The molars are bonded on the one side and the

procedure repeated on the contra-lateral side.

As the bonding base area increases, the likeli-

hood of it not seating completely increases. To

ensure proper fit of the enlarged bonding base, it is

30

Michael L. Swartz, DDS

Encino, California

successful molarbondingWITH SINGLE GINGIVALLY OFFSET BUCCAL TUBES

Figure 1. Gingivally offset brackets bonded to second

bicuspids increase bond reliability.

Figure 2. First molars are bonded using convertible

tubes and the second molars with Accent® buccal

tubes.

Figure 3. First molars are bonded with gingivally off-

set buccal tubes. The lower first molar is bonded

using Ormco Porcelain Primer.

BONDABLE MOLARS WITH GINGIVALLY OFFSET

BUCCAL TUBES – NEW ALTERNATIVE TO BANDS

An enlarged pad, gingivally offset tube and increased bondstrength combine to give you a new reason to move intobonding molars. The new gingivally offset single buccal tubeeliminates many of the problematic areas you may haveexperienced, so you can bond with new confidence.

Features That Increase Bond Strength

1. Pad enlarged in mesiodistal dimensionto increase bonding area.

2. Buccal tube welded to most-gingival edge of enhanced pad.

3. Optimesh® XRT increases bond strength35% by enhancing undercuts in the mesh.It also minimizes cleanup at debonding.

The advantages of bonding molars, such as time savings,reduced inventory, increased patient comfort and less gingi-val irritation, can be realized with the availability of the newpad configuration for Peerless® Tubes used with the Orthos™

System brackets and Straight-Wire® Micro Tubes with theDamon System 2 brackets. Ask your Ormco sales represen-tative to see the NEW Gingivally Offset Buccal Tube at theAAO in Toronto.

31

Figure 4. Molar bonding base is increased in size and

bracket placed at the gingival edge.

Figure 5. Dri-Angle is placed in the buccal and lingual

vestibules prior to bonding procedure.

2

1

3

recommended to trial fit

the bondable molar on the

patient’s model in advance. Occasionally it may be

necessary to custom contour the bonding base to

the molar.

Bonding techniques for molars apply to all

bondable brackets.

1. Isolate and obtain reasonable saliva control.

2. Etch for approximately 30 seconds per tooth.

3. Thoroughly rinse each tooth for at least 5

seconds with a forceful air/water spray.

4. Dry each tooth with a clean, dry air source.

5. Place the buccal tube, position and press firmly.

6. Remove the excess resin and reposition if neces-

sary. Note: Position the bracket well before the

resin has begun to polymerize, and leave it undis-

turbed during the initial polymerization setting.

7. Place an initial, light archwire (e.g.; nickel-titani-

um, Copper Ni-Ti®). Instruct the patient to eat a

soft diet for the first few days. Even light-initiated

bonding resins require 24 to 72 hours to reach

maximum strengths.

Reference:1. Swartz, M.: Successful Second Bicuspid Bonding, Journal ofClinical Orthodontics. Vol. 28, No. 4, Pg. 208-209.

Dr. Michael Swartz has spent more than 30years in the dental field in a variety of capacities. He began his profession as adental technician and then became a dentalmaterials research chemist, later earninghis D.D.S. from the University of SouthernCalifornia School of Dentistry. While servingas the director of research and develop-ment for Ormco, he also developed a prac-tice and began lecturing. He returned toschool and earned his certificate in ortho-dontics from the University of California atSan Francisco in 1985 and then opened aprivate practice in Encino, California, whilecontinuing to lecture both in and outsidethe U.S. He currently holds the position ofdirector of clinical affairs for Ormco, con-ducting numerous continuing educationprograms. He has given over 300 presenta-tions around the world and publishes exten-sively in both clinical and research journals.

“If that wire bothers you, just come on in and we’ll

clip it for you.” Does that sound familiar? Although

the statement is friendly and supportive, wouldn’t it

be better for both the patient and the practice if the

patient didn’t need to make a special visit to the

office for a clip or repair? What we have traditional-

ly called orthodontic emergencies come in all

shapes and sizes – the typical wire clip, a loose

bracket or band, or missing separators. It is com-

mon to accept these situations as a normal part of

practicing orthodontics; however, the entire ortho-

dontic team and patients feel the stress and endure

the deleterious effects they have on the practice.

As part of my clinical consulting, I conduct

informal interviews with patients and parents.

Their candid replies offer great insight into the

public’s perception of the office, staff and doctor.

Most patients and parents are very happy with the

doctor and staff but express concern for the extra

emergency trips to the office. Their tone of voice

begs the question, “Can something be done to

improve this?” Evaluating and understanding the

type and source of emergencies is essential to

enhancing their comfort and overall experience

with the office.

Every emergency you encounter is expensive in

lost time and takes profit out of your pocket. Each

emergency individually may not seem costly but

when you multiply several emergencies per day by

the weeks and months in each year, the costs are

significant in many practices.

Many teams could go on a European retreat

every year for the money that is lost treating avoid-

able emergencies and excess appointments.

BEWARE OF EMERGENCIES IN DISGUISE

Often emergencies are disguised and waiting to be

uncovered at a regularly scheduled appointment.

Teams who communicate to their patients to call the

office when a problem arises typically receive more

calls than those who do not. In many practices often

the problem is uncovered at the regular appoint-

ment, creating havoc with the appointment schedule

and in some cases extending the patient’s treatment

time (particularly if the repair is rescheduled).

With increasing costs and an unclear economy,

the importance of practicing in the most efficient

and effective way is essential for the spirit and

health of the practice. Tracking the details of prob-

lems found during special visits and problems

found during regular appointments, defining the

cause and time needed for their resolution, and cal-

culating the percentage of these procedures

provides valuable information so corrective proce-

dures can be developed and measured for

efficacy. To calculate the impact in your

practice, conduct a minimum two-

appointment cycle study. Record every

problem that is not in the treatment plan.

Devote doctor time to see each special-

visit patient to aid in the analysis. Then,

take the total number of clinic hours per

month and divide this number by the

hours spent during special visits and any

repairs. For example, if a practice has 120

clinical hours per month and spends 12

tracking, analyzing

and preventing

EMERGENCIES

Lori Garland Parker, MA,

Clinical Consultant,

Consulting Network

Camarillo, California

Lori Garland Parker is a clinical consultant working withorthodontic teams to maximize their talents to achieveclinical efficiency and effectiveness, develop systems forcontinuity of care, and enhance communication skills withpatients and parents. She is cofounder of ConsultingNetwork, a practice management consulting group locat-ed in California. She has written articles for numerouspublications, leads clinical workshops and lecturesthroughout the United States and abroad. Ms. Parker hasan undergraduate degree in business, a masters in organi-zational management and is a registered dental assistantin extended functions. She is a member of the AmericanSociety for Training and Development.

hours during this time repairing appliances, 10% of

clinical time is consumed with nonproductive activ-

ity. Ideally, the total percentage of all repairs (sched-

uled or found at the chair) should be 5% or less.

To effectively change the situation, analyze

each special visit to develop preventative meas-

ures. Using a detailed emergency analysis form

will provide the basic information needed for

change. Use the form entitled “Patient

Emergency/Repair Slip” to track patients who call

with an emergency as well as those who come in

for a regular appointment and need a repair. Keep

a set of forms at the front desk and in the clinic.

Collect the forms weekly and then analyze the

problems and frequency found at the chair and

the percentage of time required for those extra

procedures. Discuss ways to reduce problems by

modifying protocols. Evaluate product quality,

improve patient and parent education and/or pro-

vide additional chairside training. Receptionists

can be trained to offer over-the-phone solutions for

some emergencies, preventing the need to come to

the office.

When patients arrive with something loose,

broken or poking, it is important to ask yourself,

could this problem have been prevented? Could

something have been done differently? Here are

just a few examples of problems that could possi-

bly be avoided with specific protocols.

STRESS PROPER BONDING PROCEDURES

Because proper bonding is a cornerstone of effec-

tive orthodontics, every clinical staff member

should know proper bonding procedures and why

each part of the procedure is critical to bracket

retention throughout treatment. Shortcuts can

lead to a loose bracket months down the line,

making it difficult to link the action. In addition

33

Patient Emergency / Repair Slip

Date: _____________________________________________Patient: ___________________________________________Perceived Problem: ________________________________Patient Advised: Repair Make Comfortable

Actual Problem:____________________________________Loose Bracket Type: ______ Metal Ceramic Gold Lingual

Adhesive on: Bracket Enamel BothR 7 6 5 4 3 2 1 1 2 3 4 5 6 7L 7 6 5 4 3 2 1 1 2 3 4 5 6 7

Loose Band(Circle loose band. X loose bracket.)

Wire Poking Wire Broken Wire SlideWire Size and Type: ________________________________

Loose/Broken/Bent/Lost Appliance Type: ____________Other ___________________________________________

Cause of Problem: _________________________________Last Assistant: _________ Today’s Assistant: ___________Procedure Time: ___________________________________

When the patient calls with a clinical problem, the

receptionist completes the first four lines and attaches

the form to the patient’s chart. When the patient arrives,

the assistant completes the form. Or, when a problem is

discovered chairside, the assistant completes the form

and educates patients to call in advance with problems.

The patient is advised to make a repair appointment or

come in to be made comfortable. It is ideal if the problem

can be repaired in one appointment rather than two.

When the patient is seated, the form accompanies the

treatment card. The chairside assistant notes the actual

problem, details and cause. This information isolates

whether the patient contributed to the problem or if it is

a clinic issue, which can be helpful in preventing emer-

gencies. When the perceived problem and actual prob-

lem don’t match, the staff is alerted, prompting the

need for additional patient/parent education.

Recording the procedure time identifies the amount of

time required for various repairs or the time lost from pro-

duction appointments.

When possible, the same assistant should see the patient and

analyze the technique and communication methods, which

identifies individuals who may require additional training.

to giving attention to detail during the bonding

procedure and providing excellent patient educa-

tion, check the patient’s bite after bonding to see if

the patient is occluding on any of the brackets. I

sometimes hear doctors say, “Just try not to bite

down hard.” A few hours later the patient returns,

complaining of a bracket being loose. Ideally,

check the occlusion during diagnosis to determine

if Bite Turbos or occlusal buildups are indicated so

that the appointment time can reflect the amount

of work required.

HOW TO HANDLE HI-TECH ARCHWIRES

Many orthodontists are now bonding brackets 7-7

and using lighter, more flexible archwires. These

wires have a tendency to slide, irritating the patient.

Crimpable stops can be used on the archwire to

reduce sliding. Dimpled archwires can be used,

although care must be taken to prevent the “V”

bend from migrating into the bracket slot, causing

tipping of the central incisors. Dimpled wires are

used most effectively with self-ligating brackets. For

those offices that band the terminal teeth, anneal

and cinch wires to prevent sliding. (Of course, this

would not be advocated in cases where you wish to

increase arch length.)

PROMOTE PATIENT/PARENT EDUCATION

Good communication with your patients and par-

ents starts at the beginning of treatment. The clin-

ical team has a great opportunity to be educators

to new patients. Remember that the words you use

may sound like a foreign language. It may be the

one-thousandth time you’ve said something this

year, but it’s the first time they’ve heard it. Their

confidence in the entire team will increase if you

take the time to appropriately explain the appli-

ances and their function. People learn best when

they can see a visual, hear the explanation and

then touch or even practice with the appliance.

Prepare a hands-on show by letting them hold a

band, bracket, wire, elastic or expander. Explain

each part and how it works. Include a diagram to

support what you say. Explain the importance of

checking their braces everyday when they brush

their teeth. If something becomes loose or broken,

the patient can then be more precise about

describing the problem. When the patient or par-

ent calls the office, you can better schedule the

repair visit.

REMEMBER THE MAKEUP OF YOUR AUDIENCE

Little Cindy Lou is sitting in the chair for her first

delivery appointment. When you’ve finished, you

look at her with great sincerity and give her a

lengthy description of all the instructions she is

supposed to follow. Can she realistically remember

all that information? The attending assistant then

flags down the parent in the waiting room and

briefly describes some instructions. It is more effec-

tive to invite the parent and patient into the opera-

tory or patient education area so that both hear the

same information at the same time, and whenever

possible, divide the information into smaller, bite-

size pieces. Some information can be given at the

previous appointment followed with a question and

answer review at the subsequent visit. You can make

it fun by rewarding them for having the correct

answers. Additional wooden nickels, ortho bucks or

a coupon for a frozen yogurt can be a good incen-

tive. Many offices also give well-written instructions

for the family to refer to later.

SCHEDULE ONGOING STAFF TRAINING

I routinely see a common thread that runs through

practices regardless of the size, location or age. That

is how differently each assistant performs proce-

dures. It is vital to the practice for every assistant to

follow protocol for each procedure they perform,

from preparing for bonding, to fitting bands, to

how an archwire is tied in. To ensure continuity, it

is important to review the protocols and confirm

understanding. Monthly training sessions that

include all employees, regardless of seniority, can

be extremely valuable. More-seasoned staff mem-

bers can work with the doctor to provide training

so it stays interesting for them as well. Cover a

different procedure every month throughout the

year, and then at the beginning of the next year,

start all over again. Continual training keeps the

staff on track, aids in cross training and helps

prevent emergencies.

These suggestions are just the beginning. Once

you start to closely study the specific situations, you

will be able to develop your own protocols to

reduce procedures. Even after the initial study,

statistics should still be kept to watch improvement

over time.

This insight will provide answers for making each

patient visit a productive, efficient and enjoyable

experience for each patient and the entire team.

34

Principles of the Alexander Discipline

with Dr. Wick AlexanderOctober 11 – 13, 2001 Arlington, Texas

The value of any orthodontic technique is its ability to be repli-cated by doctors around the world, producing similar results.Orthodontists in 42 countries are applying the principles of theAlexander Discipline and consistently producing excellentresults. Learn how this discipline can help you achieve efficiencytoday for long-term effectiveness well into the future.

Through the course, you will learn:

• 20 Fundamental Principles of the Alexander Discipline thatrepresent the foundation of Dr. Alexander’s practicemethodology.

• The coordination of appropriate dentofacial orthopedics withspecific archwire and elastics sequencing to meet dento-facial goals within predictable time frames.

• How A-D bracket design concepts, including their unique torque values, aid teeth in reaching ideal positions.

• Precision placement concepts.• Retention mechanics that begin before brackets are removed,

including the 5 causes of relapse and how achieving 10 specified treatment goals greatly improve the possibility oflong-term stability.

• Treatment implications for long-term stability by examining published studies.

The Principles course is given near Dr. Alexander’s office inArlington, Texas. You will spend an afternoon seeing his patientsin various stages of treatment to observe the clinical applicationof the Discipline and witness first-hand the routine excellence ofresults achievable with consistent adherence to the principles.

Fees: $985 per orthodontist, $165 per staff member, $200 per graduate student. Limited attendance. 18 CE units.

To register, contact Ami Motsenbocker in Dr. Alexander’s office (817) 275-3233.

Adventures In OrthodonticsPalm Springs, CA • October 10–13, 2001

Let Drs. Jim Hilgers and Steve Tracey guide you on aremarkable odyssey that will change your orthodontic life.

Explore mechanics that virtually guarantee quality, on-timeresults. Unearth the lost secrets of staff enthusiasm and harmony. Discover the power of creating rich, sensory marketing experiences that will drive your patients wild.Uncover systems that will make a significant difference inyour daily practice life. Fee: $2,740.

Get your passport. Call Suzie Gleason at (949) 830-4101. It’s a jungle out there! You’re gwanna need a bwana.

MAKE YOUR EVERY VENTURE

AdventuresInOrthodontics.com

SOFT-TISSUE ANALYSIS FOR GROWTH

AND MATURATIONThe New Paradigm in Appearance-Driven

Orthodontic Diagnosis & Treatment Planning

Dr. David Sarver, DMD, MS

SEPTEMBER 20 – 22, 2001

BIRMINGHAM, ALABAMA

The new millennium has brought us patients with increased

expectations. They want to look great not only after treatment

today but also 20, 30 and 40 years from now. We can no longer

afford to focus exclusively on hard-tissue cephalometric treat-

ment goals. This approach to treatment has historically resulted

in many patients being treated to unfortunate facial outcomes.

Join Dr. David Sarver for an intensive 2 1/2-day seminar where

you will learn to conduct in-depth dynamic soft-tissue evalua-

tions that you will combine with conventional diagnostics of

function and occlusion for a comprehensive approach to treat-

ment planning that will serve your patients today and long into

their future.

This course will introduce you to a systematic approach to

diagnosis and treatment planning that is centered around the

new paradigm that emphasizes soft-tissue considerations. It is

designed in the same manner as your graduate school course-

work. The concepts are anchored in research and documented

in the literature, then supported by casework that demonstrates

the concepts clinically.

Deadline for early registration fee of $1,800 is August 1, 2001.

After August 1, course fee will be $1,900. Limited seating avail-

able, so register early.

To register, contact Lani Smith at Dr. Sarver’s office.Phone: (205) 979-7072 Fax: (205) 979-7140

www.sarverortho.com

Improving Efficiencyand Predictabilitywith the Herbst...

If you have yet to discover the many clinical advantages thatHerbst therapy can bring to your patients, or feel you would liketo strengthen your knowledge to an intermediate level, you willbe interested in this in-depth course. Join Dr. Larry Hutta whowill share his clinical knowledge of this proven treatmentoption. This workshop includes in-depth, hands-on clinicalexperiences so that you and your staff can comfortably beginusing the Herbst appliance. It also addresses in-progress issues to maximize efficiency and ensure a quality outcome.

The in-office course for doctors and key staff

will feature:

• Justification for Clinical Use of the Herbst• Case Selection Criteria• Efficient Delivery: Aspects to Delegate to Staff• Communicating the Value of the Herbst to the New Patient• How to “Fabricate” In-House or Use an Outside Lab• How to Integrate Fixed Appliances with the Herbst• Appointment Sequencing• Finishing Cases• Hands-On Clinical Experience• Fitting the Herbst on a Patient• Troubleshooting Cases in Progress• Removing the Herbst

October 5– 6, 2001 Worthington, Ohio

Fees: $1,295 for doctors, $600 for staff* 12 CE units

To register, contact Jennifer Widows at Dr. Hutta’s office.Phone: (614) 885-2000 Fax: (614) 885-2009

www.smilewithstyle.cc

*Must be accompanied by their doctor.

1717 West Collins AvenueOrange, CA 92867 USA

(714) 516-7400www.ormco.com

Print number 070-5388

order informationinspire!™ BracketsMaxillary Torq. Ang. .018 Left .018 Right .022 Left .022 RightCentral +12˚ +5˚ 443-0111 443-0110 444-0111 444-0110Lateral +8˚ +9˚ 443-0211 443-0210 444-0211 444-0210Cuspid -2˚ +13˚ 443-0311 443-0310 444-0311 444-0310Cuspid – hook -2˚ +13˚ 443-1311 443-1310 444-1311 444-1310Bicuspid -7˚ 0˚ 443-0511 443-0510 444-0511 444-0510Bicuspid – hook -7˚ 0˚ 443-1511 443-1510 444-1511 444-1510

Mandibular Torq. Ang. .018 Left .018 Right .022 Left .022 RightAnterior -1˚ 0˚ 443-0011/Universal 444-0011/UniversalCuspid -11˚ +7˚ 443-0411 443-0410 444-0411 444-0410Cuspid – hook -11˚ +7˚ 443-1411 443-1410 444-1411 444-1410

Titanium Orthos 2™ BracketsMaxillary Torq. Ang. CIS .018 Left .018 Right .022 Left .022 RightCentral +15˚ +5˚ 0˚ 448-6111 448-6110 449-6111 449-6110Lateral +9˚ +9˚ -4.5˚ 448-6211 448-6210 449-6211 449-6210Cuspid -3˚ +10˚ 0˚ 448-6311 448-6310 449-6311 449-6310Cuspid – hook -3˚ +10˚ 0˚ 448-7311 448-7310 449-7311 449-73101st Bicuspid -6˚ 0˚ 0˚ 448-6411 448-6410 449-6411 449-64101st Bicuspid – hook -6˚ 0˚ 0˚ 448-6413 448-6412 449-6413 449-64122nd Bicuspid -8˚ +4˚ 0˚ 448-6511 448-6510 449-6511 449-65102nd Bicuspid – hook -8˚ +4˚˚ 0˚ 448-6513 448-6512 449-6513 449-6512

Mandibular Torq. Ang. .018 Left .018 Right .022 Left .022 RightCentral -5˚ +2˚ 0˚ 448-6615 448-6610 449-6615 449-6610Lateral -5˚ +4˚ 0˚ 448-6625 448-6620 449-6625 449-6620Cuspid -6˚ +6˚ -4.5˚ 448-6711 448-6710 449-6711 449-6710Cuspid – hook -6˚ +6˚ -4.5˚ 448-7711 448-7710 449-7711 449-77101st Bicuspid -7˚ +3˚ 0˚ 448-6813 448-6812 449-6813 449-68121st Bicuspid – hook -7˚ +3˚ 0˚ 448-6815 448-6814 449-6815 449-68142nd Bicuspid -9˚ +3˚ 0˚ 448-6911 448-6910 449-6911 449-69102nd Bicuspid – hook -9˚ +3˚ 0˚ 448-6913 448-6912 449-6913 449-6912

Visit our Web site at www.ormco.com

Ortho Solo™ Primer and SealantOrtho Solo Kit – 740-0270Contains: Ortho Solo (four 5 ml bottles)

Applicator Brushes (38)Disposable Wells (1 pkg)Laminated Technique Guide

Ortho Solo Refill – 740-0271 Contains: Ortho Solo (one 5 ml bottle)

Demetron Optilux 501 Curing Light110 Volt – 707-0025220 Volt – 707-00278 mm Curved Turbo+ Light Guide – 707-0026

Copper Ni-Ti® ArchwireDue to the large selection, please refer to the Ormco ProductCatalog, Archwires, Section 6.

i ii iv - ormco · the lip bumper alternative dr. craig andreiko turbo wire in theory &...

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